UC-NRLF 


OF  THE 

UNIVERSITY 

OF 


BIOLOGY 
LIBRARY 


• 


WHAT  You  OUGHT  To  KNOW 
ABOUT  YOUR  BABY 

By  LEONARD  KEENE  HIRSHBERG,  B.A.,  M.D. 


A  Text  Book  for  Mothers 
on  the  Care  and  Feeding 
of  Babies,  with  Questions 
and  Answers  Especially 
Prepared  by  the  Editor 


PUBLISHED  BY 

THE  BUTTERICK  PUBLISHING  COMPANY 
HJTTERICK  BUILDING  1910  NEW  YORK 


%IOLOGY 
LIBRARY 


COPYRIGHT,  1910,  BY 
THE  BUTTERICK  PUBLISHING  COMPANY 

NEW  YORK 


*>  I 


BIOLOGY 
LIBRARY 


TABLE  OF  CONTENTS 

PAGE 

I.      THE  SLAUGHTER  OF  THE  INNOCENTS 1 

II.      THE   NEW-BORN   BABY 13 

in.    THE  BABY'S  FIRST  FEW  MONTHS 17 

IV.      THE   NURSING   BABY 21 

V.      MOTHER   AND   BABY 26 

VI.      THE   BOTTLE-FED   BABY 30 

VII.      A   CHAPTER   ON   MILK 36 

VIII.      THE   FOOD   FOR   GROWING   CHILDREN 42 

IX.      WHAT  YOU   OUGHT  TO   KNOW  ABOUT  YOUR  SCHOOL          .  51 

X.      NEED   EVERY   CHILD   HAVE   CATCHING   DISEASES?        .          .  59 

XI.      IF   YOUR   BABY   HAD    DIPHTHERIA 61 

XII.      IF   YOUR   BABY   HAD   SCARLET   FEVER  .          .          .          .71 

XIII.  WHOOPING  COUGH.    IT  KILLS  MORE  THAN  DIPHTHERIA  AND 

SCARLET   FEVER   TOGETHER 79 

XIV.  IF   YOUR   BABY   HAD   PNEUMONIA 85 

XV.       NEED  EVERY   CHILD  HAVE   MEASLES?                                .          .  91 


M8152Q2 


Appreciatively  dedicated  to  Mr. 
George  W.  Wilder,  whose  earnest 
efforts  for  the  child's  broader 
welfare  prompted  this  book. 


A  WORD  TO  MOTHERS 

This  is  a  book  that  THE  DELINEATOR  sends  to  mothers  because 
we  believe  that  the  American  woman  needs  a  knowledge  of  child 
hygiene.  The  census  statistics  show  that  one  in  every  six  of  the 
children  born  in  the  United  States  does  not  live  to  be  one  year  of 
age.  A  great  many  of  those  who  survive  grow  up  to  a  life  of  suffer- 
ing and  incapacity,  handicapped  in  the  struggle  of  existence,  for 
from  70  to  90  per  cent,  of  American  school-children  have  one  or 
more  physical  defects.  The  conservation  of  humanity,  the  per- 
fection of  the  race,  is  the  watchword  of  to-day.  More  and  more  the 
doctor  is  interpreting  it  as  his  mission  to  teach  people  how  to  keep 
well.  And  the  place  to  begin  is  with  the  babies.  Mother  instinct 
has  done  much  through  the  ages.  But  mother  training  equipped 
with  all  the  knowledge  that  science  can  give,  may  do  much 
more.  For  the  new  motherhood  that  shall  know  how,  this  book  is 
published. 


CHAPTER  I.— THE  SLAUGHTER  OF  THE  INNOCENTS 

WOMAN  enters  a  car  with  a  baby  in  her  arms. 
An  old  gentleman  rises  and  gives  her  a  seat 
beside  another  woman.  The  baby  begins  to 
cry.  The  mother  bounces  him  up  and  down. 

"I  suppose  the  poor  little  dear  is  teething," 
ventures  the  stranger  affably. 

"Yes,"  replies  the  mother.  "He  cut  two 
last  week  and  now  he's  on  his  third.  It's  put 
him  all  out  of  sorts.  Last  night  he  had  a  croupy  attack,  and  if 
I  hadn't  given  him  a  dose  of  ipecac  at  once  we  might  have  had 
to  send  for  the  doctor." 

The  mother  takes  a  milk  bottle  from  her  satchel,  carefully  wipes 
the  nipple  with  a  rag,  and  gives  it  to  her  offspring.  A  gurgle — 
and  he  is  still.  The  women  talk  on.  The  child  empties  the  bottle 
and  begins  to  fret  again.  The  mother  produces  a  rubber  "paci- 
fier" from  her  capacious  hand-bag,  and  he  begins  to  gnaw  it. 
"Is  he  a  good  child?"  asks  the  stranger. 

"A  real  angel,"  replies  the  mother  proudly.  "He  never  wakes 
more  than  twice  a  night,  and  then  a  half-bottle  of  milk  quickly 
quiets  him.  My  mother  has  taken  complete  charge  of  him.  She 
has  raised  eight  children  and  knows  more  than  the  doctor.  She 
won't  let  me  give  him  anything  but  boiled  milk." 

A  common  enough  conversation,  certainly.  You  have  heard 
it  yourself  a  dozen  times,  in  trolley  car  and  train.  It  seems  utterly 
harmless — and  yet  there  is  in  it  evidence  enough  to  convict  the 
mother  of  no  less  than  seven  separate  and  distinct  crimes — of 
omission,  commission,  ignorance,  indulgence  and  superstition — 
against  her  innocent  youngster,  and,  indirectly,  against  posterity, 
her  country  and  long-suffering  humanity. 

Let  us  go  back  and  listen  again.  The  woman  enters  the  car. 
The  baby  begins  to  cry.  She  bounces  it  up  and  down.  Crime 
number  one!  Babies  should  not  be  bounced  up  and  down.  It 
nauseates  them;  it  strains  them;  it  makes  them  unhappy. 

1 


The  baby  is  teething.  "It's  put  him  out  of  sorts."  Crime 
number  two! — this  time  one  of  superstition.  Teething  does  not 
put  a  healthy  baby  "out  of  sorts."  If  the  little  fellow  is  a  normal 
child  his  teeth  come  through  the  gums  without  pain.  If  he  cries 
at  the  time,  the  chances  are  that  it  is  because  maternal  ignorance 
has  given  him  bad  habits.  If  that  is  not  true,  he  is  sick,  and  the 
chances  are  that  the  sickness  has  its  seat,  not  in  his  gums,  but  in 
his  stomach. 

"Last  night  he  had  a  croupy  attack,  and  if  I  hadn't  given  him 
ipecac."  Crime  number  three!  For  true  croup,  ipecac  is  no 
remedy.  For  a  slight  cough — and  most  mothers  group  all  dry 
coughs  under  the  generic  name  of  "croup" — no  medicine  is  needed. 
The  ipecac  makes  the  little  dear  vomit;  he  becomes  exhausted  and 
falls  into  a  heavy  sleep.  Nature  cures  his  cough. 

The  mother  takes  a  bottle  from  her  hand-bag.,  wipes  the  nipple 
and  gives  it  to  her  offspring.  A  gurgle — and  he  is  still.  Crime 
number  four!  The  hand-bag  is  full  of  germs,  the  nipple  is  full  of 
germs,  the  rag  used  to  wipe  it  is  full  of  germs  and  the  bottle  is  full 
of  germs.  Yet  the  baby  lives!  And  why?  Because  the  human 
body  is  so  tough  that  nine  times  out  of  ten,  in  a  battle  with  germs, 
it  wins.  But  the  tenth  time  it  loses. 

The  child  empties  the  bottle  and  begins  to  fret.  The  mother 
produces  a  "pacifier."  Crime  number  five!  The  "pacifier"  is 
ev^;i  dirtier  than  the  milk  bottle.  Germs  thrive  upon  it  like  bar- 
nacles upon  a  floating  log.  If  the  baby  is  in  luck  they  are  the 
comparatively  mild  and  puny  germs,  that  cause  blisters  in  the 
mouth,  sore  gums,  stomach-ache,  diarrhea  and  rashes.  If  fortune 
frowns  upon  him,  they  are  the  virulent  and  deadly  germs  of  cholera 
infantimi. 

The  baby  is  an  angel.  "He  seldom  wakes  more  than  twice  a 
night."  Crime  number  six! — this  time  one  of  maternal  fondness. 
A  healthy  baby  should  sleep  from  dusk  to  dawn  without  waking. 
If  he  doesn't,  it  is  because  his  mother  has  permitted  him  to  acquire 
bad  habits. 

"My  mother  has  taken  charge  of  him."  Crime  number  seven! 
True  enough,  the  dear  old  lady  has  raised  eight  of  her  own.  But 
the  acts  of  her  daughter  prove  that  she  still  clings  to  a  whole  con- 
fession of  ancient  delusions.  She  believes,  for  instance,  that  normal 
teething  should  torture  babies  and  make  them  cry.  She  believes 
that  babies  should  be  nauseated  with  ipecac  whenever  they  happen 

2 


to  cough.  She  believes  that  wiping  a  rubber  nipple  with  a  rag 
makes  it  clean.  She  believes  that  babies  should  be  bounced  up 
and  down,  and  that,  when  they  cry,  they  should  be  given  "paci- 
fiers" to  gnaw.  She  believes,  in  a  word,  in  medical  fallacies  that 
were  venerable  in  the  days  of  Hippocrates.  And  yet  she  "knows 
more  than  the  doctor!" 

Is  the  picture  overdrawn?  Is  it  a  farce?  Not  at  all.  Look 
at  it  squarely  and  you  will  see  that  it  is  tragedy — tragedy  of  the 
gloomy,  every-day  sort  we  have  learned  to  watch  unheeding.  A 
hundred  thousand  American  babies  die  every  year.  Fully  half  of 
these  deaths  are  the  sad  result,  I  believe,  of  unwise  feeding, 
of  stupid  dosing,  of  precedent,  habit,  custom  and  superstition. 

On  the  face  of  it,  of  course,  it  seems  reasonable  to  maintain  that 
a  woman  who  has  brought  up  eight  children  of  her  own,  and  watched 
by  the  bedsides  of  perhaps  a  dozen  others,  should  know  something 
about  the  art.  But  this  conclusion  is  based  upon  faulty  logic. 

The  fact  that  grandma's  eight  children  lived  shows  only  that  they 
were  sturdy  and  lucky — that  their  natural  recuperative  powers 
enabled  them  to  survive  her  blunders  or  they  that  were  rescued  by 
some  hard-working  family  doctor.  The  knowledge  that  she  ac- 
quired in  raising  them  consists,  in  good  part,  of  things  that  are 
obviously  untrue.  Because  she  once,  or  twice,  or  eight  times 
observed  that  a  certain  procedure  seemed  to  be  followed  by  a  cer- 
tain result,  she  maintains,  to-day,  as  an  uncontrovertible  propo- 
sition, that  that  same  procedure  will  be  followed  by  that  same  result 
inevitably  and  always. 

The  doctor  is  a  mere  man,  and  it  may  be  he  has  no  babies  of 
his  own,  but  his  knowledge  of  babies,  even  accepting  the  grand- 
mother's test,  is  infinitely  greater  than  her  own.  He  has  walked 
the  hospitals  for  five  years  and  he  has  seen  and  studied,  not  eight 
babies,  but  eight  hundred  or  a  thousand.  He  has  read  the  books; 
he  has  listened  to  the  great  physicians.  He  has  given  his  days  and 
nights  to  the  investigation  of  human  maladies — their  cause  and 
their  cure. 

And  so,  is  it  not  reasonable,  when  he  says  that  contaminated 
cow's  milk  is  not  good  for  babies,  and  that  "pacifiers"  are  likely 
to  inoculate  them  with  the  germs  of  cholera  infantum — is  it  not 
reasonable  to  set  up  his  authority  against  that  of  the  grandmother 
whose  eight  babies  were  lucky  and  so  faced  these  perils  unslain, 
if  not  unscathed? 

3 


Two  considerations  must  be  kept  ever  in  mind  in  discussing  the 
care  of  infants.  One  is  the  fact  that  silly  superstitions,  far  from 
being  confined  to  the  slum  mothers  who  give  their  babies  beer  and 
dress  them  in  wadded  flannels,  are  rampant  to  an  astonishing 
degree  among  women  otherwise  intelligent  and  presumably  sane. 
The  other  is  the  fact  that  the  ignorance  of  the  mother,  even  when 
the  baby  passes  childhood  in  apparent  health  and  safety,  often  paves 
the  way  for  suffering  later  on. 

The  tendency  to  blame  all  sorts  of  things  upon  intestinal  para- 
sites affords  a  double  illustration.  A  baby,  let  us  say,  is  restless 
and  fretful.  Its  body  twitches  and  it  moves  about  in  its  sleep. 

It  awakes  suddenly  and  with  a  frightened  cry.  By  day  it 
squirms  in  its  high  chair,  picks  at  its  nose  and  scratches  the  back 
of  its  neck.  Its  mother  is  alarmed,  and  so  its  grandmother,  two 
aunts  and  four  neighbors  are  called  in  consultation.  The  grand- 
mother has  raised  eight  children;  the  aunts,  between  them,  have 
raised  nine;  and  the  neighbors  point  proudly  to  twenty.  Here 
we  have  a  gigantic  conglomeration  of  expert  aid.  Thirty-seven 
human  beings  are  monuments  to  the  science  of  seven  mothers. 

"The  poor  dear  has  worms,"  says  the  grandmother. 

"Give  him  some  quassia, "  says  one  of  the  aunts. 

"Why  not  try  turpentine?"  says  the  other. 

"Or  cucumber  seeds,"  suggests  one  of  the  neighbors.  "Wnen 
my  little  Johnnie — 

So  the  corner  druggist  makes  a  sale  of  shop-worn  goods,  the  child 
swallows  a  staggering  dose — and  during  the  ensuing  forty-eight 
hours  it  spends  most  of  its  time  in  a  stupor  that  seems  like  sleep. 
Isn't  this  a  proof  that  it  has  been  cured — by  the  quassia,  the  tur- 
pentine or  whatever  other  specific  the  seminary  of  experts  agreed 
upon?  Of  course  it  is! 

But  all  the  same  a  rash  intruder  might  make  the  observation 
that  babies  are  not  designed  by  nature  for  the  ingestion  of  drugs,  that 
a  comparatively  small  dose  shocks  and  exhausts  them,  and 
that  this  exhaustion  is  often  mistaken  for  healthy  and  refreshing 
slumber.  And  this  same  observer,  sometime  later  on,  might  point 
out  that  the  baby  is  again  wakeful  and  restless — that  it  again 
squirms  in  its  bed  and  chair  and  again  cries  in  the  night. 

In  the  end,  perhaps,  it  ceases  its  troubling,  and  the  "cure"  is 
ascribed  to  the  repeated  doses  that  have  been  forced  down  its  throat. 
But,  on  the  other  hand,  there  is  a  chance  that  it  will  show  no  im- 

4 


provement,  and  that  its  father,  with  courage  born  of  alarm,  will 
at  last  invade  the  prerogatives  of  the  feminine  side  of  the  house 
and  call  in  a  physician.  The  physician,  if  all  of  his  honesty  has  not 
oozed  out  of  him,  will  make  a  thorough  examination,  and  the 
probability  is  that  he  will  find  the  baby  to  be  suffering  from  adenoids 
or,  perhaps,  St.  Vitus's  dance. 

Adenoids  are  curious  little  cauliflower-like  growths  which  ap- 
pear at  the  juncture  of  the  nasal  cavity  and  the  pharynx.  They 
are  often  observed  at  birth,  but  they  seldom  cause  discomfort  until 
some  months  later.  Then  they  interfere  with  respiration  and  cause 
the  baby  to  be  restless.  It  tosses  in  its  sleep  and  wakens  suddenly, 
crying  out  as  if  in  distress. 

If  adenoids  are  permitted  to  remain  they  deform  the  mouth, 
teeth,  throat,  chest  and  face.  At  their  worst  they  produce  pop- 
eyes  and  what  is  called  a  frog-face.  They  cause  mouth-breathing, 
with  all  its  attendant  evils.  They  open  the  way  for  a  hundred  and 
one  ills,  from  rupture  of  the  ear-drum,  running  from  the  ears, 
coughs  and  tonsilitis,  to  pulmonary  tuberculosis. 

A  slight  operation  suffices  to  remove  them.  The  baby  suffers 
little  pain  and  loses  little  blood.  Out  they  come — and  with  them 
the  overgrown  tonsils  that  commonly  accompany  them.  If  they 
are  suffered  to  remain,  they  may  never  be  discovered.  But  it  is 
certain  that  in  one  way  or  another,  they  will  cause  damage. 

The  mother  of  eight  may  say  that  she  never  heard  of  adenoids. 
But  despite  her  reluctance  to  include  them  in  her  lexicon,  they 
actually  do  exist.  One  child  in  every  three  has  them.  In  low- 
lying  sea-coast  towns  they  may  be  found  in  two  children  in  every 
three.  A  generation  ago  they  were  unobserved,  and  it  is  only  for 
a  decade  or  so  that  their  great  importance  has  been  fully  realized. 
And  so  it  is  no  wonder,  perhaps,  that  the  average  grandmother 
is  unaware  of  them.  But  the  poor  baby!  It  pays  for  her  igno- 
rance— in  pain,  wakeful  nights  and  misery,  now  and  hereafter! 

Given  a  child  born  at  full  term  and  of  healthy  parents,  and  it 
is  safe  to  say  that  half  of  its  infantile  ills  are  due  to  the  ignorance 
of  its  mother.  She  loves  it,  and  so,  when  it  sets  up  a  cry,  she  nurses 
it — and  it  becomes  an  ill-mannered  little  glutton,  with  a  penchant 
for  colic.  She  loves  it,  and  so  she  feeds  it  too  often  and  too  much — 
and  it  becomes  ripe  for  cholera  infantum.  She  loves  it,  and  so, 
after  it  has  had  its  fill,  she  coddles  it,  bounces  it  and  plays  with 
it — and  it  vomits. 

5 


Despite  the  general  idea  that  some  babies  are  foreordained  to 
suffer  from  colic  and  that  nothing  can  save  them,  it  is  nearly  al- 
ways preventable.  Its  appearance  indicates  that  the  little  sufferer 
is  getting  food  of  a  sort  his  stomach  can't  digest,  and  missing  food 
of  the  sort  he  needs.  It  means  that  his  mother,  if  he  is  at  the 
breast,  is  in  no  condition  properly  to  feed  him.  It  means  that  the 
infant  food  he  is  taking,  if  he  is  upon  the  bottle,  is  poisoning  him. 
The  remedy  in  each  case  is  a  consultation  with  a  competent  phy- 
sician. This  man,  though  not  a  mother  himself,  will  determine 
exactly  what  the  baby  needs,  and  he  will  write  a  prescription  that 
will  insure  the  baby's  getting  it. 

The  word  "prescription"  may  suggest  the  idea  of  drugs — of 
paregoric,  ipecac,  spirits  of  nitre  and  all  the  other  ancient  contents 
of  the  infantile  medicine-chest — but  in  this  case  the  prescription 
will  be,  not  for  drugs,  but  for  milk.  What  the  baby  needs  is  pure, 
nourishing  food,  and,  failing  a  good  maternal  supply,  the  best  food 
he  can  possibly  get  is  cow's  milk — cow's  so  modified  that  it  contains 
the  exact  amount  of  proteids,  of  sugar  and  of  fats  that  he  needs. 

In  all  large  cities  there  are  now  laboratories,  in  charge  of  skilled 
men,  which  make  a  business  of  supplying  cow's  milk  that  has  been 
modified  according  to  physicians'  prescriptions.  Plain  cow's 
milk  is  bad  for  babies,  even  after  it  has  been  boiled,  because  it 
lacks  certain  constituents  that  they  need,  and  contains  others 
that  they  should  not  be  called  upon  to  digest.  The  work  of  modi- 
fying it  is  done  scientifically  and  cleanly,  and  the  result  is  the  nearest 
approach  to  a  perfect  food  that  science  has  yet  evolved. 

The  laboratory  man  will  compound  this,  and  the  result  will 
be  a  bottle  of  milk — of  milk  that  seems  to  the  feminine  expert  to 
be  quite  like  ordinary  milk.  But  when  the  sick  baby  has  taken 
it  at  the  hours  and  intervals  laid  down  by  the  physician  he  will 
have  colic  no  longer,  and  in  the  process  he  will  have  acquired  good 
habits. 

The  notion  that  constant  nocturnal  bawling  is  a  diversion 
necessary  to  the  baby's  well-being  is  a  fallacy  as  old  as  the  super- 
stition that  sulfur  and  molasses  are  good  for  the  blood.  If  an  in- 
fant wakes  and  cries  at  night  it  is  an  evidence  of  one  of  two  things — 
either  it  is  ill  or  it  has  been  permitted  to  acquire  bad  habits.  If 
it  is  ill,  the  best  thing  to  do  is  to  send  for  a  doctor. 

If,  after  a  thorough  examination,  he  decides  that  it  is  in  good 
health,  the  fault  lies  with  its  mother.  She  fed  it  whenever  it 

6 


cried;  she  made  it  associate  the  act  of  crying  with  the  production 
of  a  meal ;  she  fastened  upon  it  the  habit  of  feeding  when  it  should 
be  asleep. 

A  healthy  infant,  properly  trained,  should  go  to  sleep  every 
night  at  seven  o'clock  and  sleep  soundly  until  daylight.  It  should 
be  fed  when  it  awakes  in  the  morning,  and  it  should  be  fed  again 
at  regular  intervals  throughout  the  day — every  two  hours  when 
it  is  very  young,  and  every  three  or  four  hours  as  it  grows  older. 
Its  last  meal  should  come  just  before  it  is  tucked  into  its  crib.  And 
if  it  cries  for  food  after  that,  it  should  be  permitted  to  cry  until 
the  habit  is  broken. 

The  only  things  that  should  ever  touch  an  infant's  lips,  during 
its  first  year,  are  boiled  water  and  milk — mother's  milk,  or  cow's 
milk  properly  modified.  If  it  is  born  strong  and  sound  and  is 
properly  fed  it  will  need  no  medicines.  And  all  other  things — 
mush,  soup,  porridge,  fruits,  pretzels,  alcohol,  vegetables,  meats, 
"pacifiers,"  rubber  rings,  orris-root,  sugar,  rattles  and  its  nurse's 
fingers — are  abominations  in  its  mouth.  They  spell  indigestion 
in  a  dozen  forms,  not  to  speak  of  colic,  fevers,  wakefulness,  faulty 
growth  and  cholera  infantum. 

Next  to  unwise  feeding,  as  a  source  of  infantile  ills,  comes  over- 
coddling.  Kissing  the  baby  after  it  has  been  fed,  for  instance, 
is  very  likely  to  cause  it  to  vomit,  and  vomiting  is  even  more  ex- 
hausting to  a  child  than  to  an  adult.  The  desire  of  all  aunts, 
cousins,  sisters,  grandmothers,  neighbors,  parlor  maids,  cooks, 
seamstresses  and  other  members  of  the  affectionate  sex  to  "hold 
the  baby"  and  kiss  it,  and  of  all  uncles,  grandfathers  and  bachelor 
friends  of  its  father  to  hoist  it  to  the  ceiling,  should  be  rigorously 
denied.  Such  delightful  domestic  pastimes  do  the  baby  no  good, 
and  very  often  hurt  it.  At  best  it  becomes  peevish.  At  worst 
it  shows  signs  of  hysteria.  Children  should  play — when  they  are 
old  enough  to  play — with  children. 

And  let  there  be  an  end  to  home  doctoring!  Most  intelligent 
mothers  have  learned  to  be  wary  of  soothing-sirups,  but  the  great 
majority  still  put  a  good  deal  of  faith  in  paregoric.  It  is  a  favorite 
for  diarrhea,  stomach-ache  and  a  host  of  other  ills.  Often,  perhaps, 
it  gives  what  seems  to  be  relief,  since  opium,  its  main  constitu- 
ent, is  the  greatest  of  the  gifts  of  the  gods.  But  is  it  safe  for 
mothers  to  give  their  children  opium? 

In  most  other  home  remedies  there  is  less  positive  danger,  but 

7 


all  of  them  do  harm  in  at  least  two  ways:  they  postpone  the  be- 
ginning of  proper  treatment,  and  they  subject  the  poor  baby  to 
excessive  and  harmful  medicating. 

Deliberate  neglect  of  her  baby  is  a  felony  seldom  proved  against 
an  American  mother — or  against  any  mother,  for  that  matter. 
Yet  I  sometimes  feel  that  neglect,  in  the  long  run,  would  often  do 
less  damage  than  too  much  loving.  The  classical  "villainess" 
of  American  romance  and  folklore,  who  wastes  her  time  in  social 
gaiety  and  hands  over  her  offspring  to  professional  nurses,  seems 
like  some  revolting  and  inhuman  monster,  and  perhaps  she  is. 
But  did  it  ever  occur  to  you,  oh,  indignant  critic,  that  the  children 
of  such  callous  mothers,  though  they  may  lack  a  proper  reverence 
for  the  canon  law  and  the  ordinances  against  motor  speeding, 
are  nevertheless  uncommonly  healthy  animals?  The  fashionable 
young  woman  appears  in  the  divorce  courts  a  bit  too  often,  but  she 
seldom  lands  in  a  hospital.  She  is  vigorous  and  strong.  She  has 
a  sound  digestion.  She  swings  her  golf  club  with  muscular  arms. 
And  her  brother  is  tough — literally  as  well  as  figuratively.  He 
has  no  morals,  but  he  has  a  good  wind  and  strong  legs. 

The  cause  of  all  this,  I  fancy,  lies  in  the  fact  that  these  young 
persons  were  never  coddled.  Professional  nurses  fed  them,  with 
inhuman  disregard  for  their  yells,  upon  proper  food  at  proper 
intervals.  An  early  realization  of  the  futility  of  bawling  led  them 
into  regular  habits.  They  swallowed  no  soothing-sirups;  they 
took  no  camomile;  they  knew  not  the  flaxseed  poultice  nor  the 
home-made  liniment.  No  one  rocked  them  to  sleep ;  no  one  tickled 
them ;  no  one  bounced  them  up  and  down.  They  were  kissed  only 
upon  state  occasions — and  then  in  a  gingerly,  aseptic  way, 
upon  the  forehead  or  the  cheek. 

Consider  now  the  baby  of  the  great  middle  class — the  baby  en- 
throned upon  a  mountain  of  pillows,  the  baby  whose  mother  trem- 
bles when  he  cries  and  worries  for  days  about  the  mole  on  his  neck 
and  wears  herself  out  slaving  for  him.  How  zealously  she  guards 
him  against  drafts!  He  is  clothed  in  warm  flannels;  his  cradle — 
he  should  really  sleep  in  a  comfortable  crib — is  dragged  far  from 
the  window ;  he  is  buried  in  bedclothes,  and  he  is  kept  indoors  on 
windy  days.  The  mother's  intentions  are  good,  beyond  a  doubt, 
but  her  prophylaxis  is  hopelessly  fatuous.  The  baby  needs  air 
beyond  all  things.  He  should  spend  as  much  as  possible  of  his 
first  year  in  the  open.  He  should  be  taken  out  in  his  go-cart 

8 


upon  every  fair  day,  and  kept  out  in  all  the  intervals  between 
meals.  He  should  sleep  in  a  room  with  open  windows,  Winter 
and  Summer. 

Babies  should  be  put  into  short  clothes  at  their  birth  if  they 
come  into  the  world  in  warm  weather,  and  at  two  months  if  they 
first  see  the  earth  in  a  mantle  of  snow,  and  thereafter  they  should 
be  clad  very  sparingly. 

An  infant's  skin  is  so  tender  that  perspiration  quickly  causes 
it  to  chafe.  To  guard  against  this  the  baby  should  be  kept  cool 
and  bathed  often.  And  after  it  has  been  bathed  it  should  be  laid 
on  a  clean  sheet  and  not  first  frescoed  with  powder  and  then  swathed 
in  habiliments  fit  only  for  a  mummy. 

In  Winter  the  fact  that  the  weather  is  cold  should  not  condemn 
the  child  to  hot  rooms  and  bad  air.  It  is  easy  enough  to  dress  it 
warmly  without  burying  it  in  clothes,  and  if  it  is  warmly  dressed 
the  cold  will  not  hurt  it.  Let  it  not  be  understood  that  I  am  ar- 
guing that  infants  are  fit  to  face  blizzards.  But  in  most  parts 
of  the  United  States  blizzards  are  rare,  and  the  majority  of  Winter 
days,  though  cold,  perhaps,  are  fine.  On  such  days  the  baby 
should  spend  hour  after  hour  outdoors.  Awake  or  dozing,  it  should 
be  wheeled  up  and  down  in  the  pale  sunshine. 

The  popular  notion  that  all  babies  are  predestined  to  suffer  at- 
tacks of  a  long  string  of  infantile  ills,  from  chicken-pox  to  diphtheria 
is  utter  foolishness.  There  is  no  reason,  whatever,  why  a  child 
should  take  any  of  these  diseases.  A  baby  that  has  grown  ac- 
customed to  sunlight  and  the  open — that  sleeps  soundly,  digests 
normally  and  has  lost,  seemingly,  all  capacity  for  taking  cold — is 
little  likely  to  fall  a  victim  to  the  common  infections.  Its  veins 
are  full  of  good,  red  blood,  and  this  blood  is  prepared,  at  all  times, 
to  wage  a  terrific  war  upon  germs.  And  even  in  case  the  germs 
prevail,  and  the  baby  grows  ill,  its  chance  of  having  but  a  mild 
attack  and  of  recovering  quickly  and  without  distressing  and  linger- 
ing complications  is  infinitely  greater  than  that  of  the  vulnerable, 
ailing,  coddled  child.  The  evil  effects  of  coddling  do  not  appear 
at  once.  If  they  did,  there  would  be  no  coddling.  But  they  ap- 
pear certainly,  none  the  less,  and  too  often  they  make  the  difference 
between  a  mild  case  of  scarlet  fever  and  a  very  bad  one,  with 
Bright 's  disease  following  after. 

The  baby  that  is  fed  every  time  it  cries,  whose  stomach  is  over- 
loaded day  and  night  with  improper  food,  is  the  baby  that  falls 

9 


before  the  germs  of  cholera  infantum.  This  is  less  often  a  malady 
of  filth — in  the  popular  conception  of  the  word — than  a  disease  bred 
of  faulty  nutrition,  overbundling  and  grandmotherly  therapeutics. 
A  flaxseed  poultice  may  lay  the  foundation  for  pneumonia.  A 
drop  of  paregoric  may  kill.  A  mistaken  diagnosis  of  "worms" 
may  mean  St.  Vitus's  dance,  or  adenoids  and  long  years  of  suffering. 
A  flannel  garment  may  pave  the  way  for  measles  or  diphtheria. 
A  home-brewed  tea  may  delay  the  physician  until  it  is  too 
late.  A  kiss  may  spell  tuberculosis. 

Home  dosing  and  coddling — herein  we  have  the  foot-notes  that 
explain  the  tables  of  infant  mortality.  Throw  away  your  pare- 
goric, your  ipecac,  and  your  camomile!  These  things  are  abom- 
inations as  bad  as  your  patent  soothing-sirups  and  sarsaparillas. 
Your  baby  doesn't  need  drugs,  but  pure  food  and  fresh  air.  If 
he  seems  ill,  let  your  doctor  prescribe  for  him.  Nine  times  out  of 
ten  he  will  order  milk  rather  than  purges.  Open  the  windows  and 
let  in  the  air!  Throw  away  your  stock  of  chest-protectors,  belly- 
bands  and  padded  woolens!  Let  the  baby  kick!  Let  him  breathe! 
Let  him  be  bare! 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  I 

Is  there  anything  you  would  not  do  to  save  your  baby? 

No. 

Is  anything  too  good  for  your  baby? 

No. 

Do  you  want  the  best  advice  in  bringing  up  your  baby? 

Yes. 

Is  grandma's  advice  or  your  neighbor's  advice  the  best? 

No. 

To  whom  can  you  safely  trust  your  baby? 

To  the  doctor. 

Should  a  mother  wait  till  her  baby  is  sick  before  taking  it  to  the 
doctor? 

No.    The  doctor  can  tell  a  mother  many  things  about  the  care 
of  her  baby  that  will  keep  it  from  getting  sick. 

How  often  should  your  doctor  see  your  baby,  whether  it  is  well  or 
sick? 

At  least  once  in  two  weeks  until  two  years  old. 

10 


Is  this  not  an  unnecessary  extravagance? 

No.  The  cost  of  a  ten  minute  examination  of  the  baby  by  the 
doctor  once  in  two  weeks  will,  in  the  long  run,  be  very  much  less 
than  the  cost  of  the  doctor's  visits  and  the  bills  for  medicines  if 
the  baby  has  a  severe  illness. 

How  many  babies  die  under  one  year  of  age  in  the  United  States 
to-day? 

One  out  of  every  six  babies  born  dies  before  it  reaches  one  year 
of  age.  One  out  of  every  four  babies  born  dies  before  it  reaches 
five  years  of  age. 

Shall  your  baby  be  the  sixth  one? 

No. 

How  can  you  save  it? 

By  striving  to  learn  the  best  methods  known  by  experts  on  feed- 
ing, clothing  and  caring  for  the  baby. 

What  are  some  of  the  superstitions  and  customs  of  mothers  that 
make  babies  sick? 

Soothing  sirups;  pacifiers;  feeding  the  baby  whenever  it  cries; 
patent  medicines;  patent  baby  foods;  family  remedies;  the  idea 
that  babies  are  doomed  to  be  sick  when  their  teeth  come ;  that  the 
baby  must  be  constantly  played  with  or  kept  in  constant  motion; 
the  idea  that  because  so  many  babies  die  to-day  they  must  always 
die. 

What  are  the  diseases  of  which  babies  die? 

Diarrhea;  pneumonia;  whooping  cough;  tuberculosis;  menin- 
gitis and  a  few  of  contagious  diseases  such  as  diphtheria;  measles 
and  scarlet  fever. 

How  many  of  these  diseases  are  preventable? 

All  of  them. 

How  many  of  them  are  due  to  ignorance  on  the  part  of  the  mothers? 

All  of  them. 

How  many  of  them  are  germ  diseases? 

All  of  them. 

How  do  germs  get  into  the  babies'  system? 

Through  impure  milk;  through  sucking  a  dirty  pacifier  or  rag; 
through  drinking  water  that  has  not  been  boiled ;  through  nursing 
bottles  and  nipples  that  have  not  been  sterilized. 

What  is  the  best  way  to  make  a  baby  able  to  resist  germs? 

By  keeping  it  out  in  the  air  all  the  time,  and  by  being  sure  that 
it  is  well  nourished. 

11 


Why  is  the  pacifier  habit  or  the  habit  of  sucking  the  thumb  especially 
bad? 

Because  it  forms  the  habit  of  breathing  through  the  mouth. 
This  encourages  the  growth  of  adenoids.  Because  the  tissues 
of  the  throat  become  infected  with  germs  taken  in  this  way. 

What  are  adenoids? 

Adenoids  are  small  spongy  lumps  that  grow  back  of  the  nose 
and  partly  close  the  nostrils. 

Why  should  adenoids  be  removed? 

Because  if  permitted  to  remain  in  the  growing  child,  the  mouth, 
teeth,  face  and  chest  become  deformed;  because  they  are  the 
direct  cause  of  deafness,  constant  colds  and  throat  trouble,  and 
often  lead  to  pulmonary  tuberculosis. 

How  can  adenoids  be  removed? 

By  a  slight  surgical  operation  which  can  be  performed  in  less 
than  a  minute  and  which  causes  very  little  pain,  and  but  slight 
loss  of  blood. 

Why  are  mothers  glad  when  they  have  not  delayed  in  having  adenoids 
removed? 

Because  the  change  in  the  health  and  happiness  of  the  child 
is  so  immediate  and  so  marked. 

What  is  the  young  mother's  gospel? 

Clean  air,  clean  milk,  clean  baby. 


12 


CHAPTER    II.— THE    NEW-BORN    BABY 

UST  as  every  man  is  firmly  convinced  that  he  is 
perfectly  competent  to  drive  a  nail,  run  a 
newspaper  or  direct  the  destinies  of  the  nation, 
so  every  woman  believes  that  she  knows  how 
to  care  for  a  baby.  The  only  difference  is  that 
the  man  looks  upon  his  fitness  as  the  result 
of  profound  study  and  a  high  order  of  intellect, 
while  the  woman,  more  modest,  gives  the 
credit  to  instinct.  Both  are  wrong. 

Instinct  and  mother  love,  it  is  plain,  will  restrain  even  the  most 
ignorant  young  mother  from  feeding  her  baby  upon  cucumbers, 
but  in  other  ways,  unless  she  is  well  instructed,  she  is  apt  to 
make  mistakes,  and  these  mistakes  may  be  costly.  If  the  instruc- 
tion she  receives  comes  from  one  of  those  well-meaning  old  women 
who  radiate  maternal  lore  so  copiously  in  all  communities,  her 
blunders  are  certain  to  be  numerous  and  bad.  But  if  she  is 
sensible,  and  seeks  advice  from  a  physician  or  a  graduate  nurse, 
she  will  learn  a  great  deal,  and  the  things  that  she  learns  will 
have  the  merit  of  being  true.  With  a  good  groundwork  thus 
laid,  she  will  approach  unaccustomed  problems  and  emergencies 
in  an  intelligent,  efficient  fashion. 

In  choosing  the  physician  who  is  to  assist  in  bringing  her  first 
child  into  the  world,  it  is  well  for  the  young  mother  to  be  extremely 
critical.  Unluckily  enough,  all  holders  of  the  doctor's  degree  are 
not  of  the  first  rank,  and  very  often  the  man  with  the  most  impres- 
sive beard  and  of  the  most  heartening  geniality  is  the  least  competent. 
The  best  thing  to  do  is  to  select  a  practitioner  who  has  been 
trained  in  a  college  of  the  best  sort  and  who,  whether  young  or  old 
has  standing  in  his  profession.  If  he  is  of  such  admitted  compe- 
tence that  his  fellow  physicians  are  known  to  seek  and  respect  his 
advice,  so  much  the  better. 

Most  towns  will  have  a  doctor  of  hospital  experience  and  skill 
in  conducting  infant  cases.  His  fees  may  seem  large,  but  he 

13 


well  earns  them,  for  his  presence  is  an  assurance  against  many 
very  distressing  accidents.  The  majority  of  the  dangers  attending 
childbirth,  indeed,  disappear  with  scientific  care.  This  is  especially 
true  of  the  complications  due  to  infections — childbed  fever  and 
blood-poisoning  in  the  mother,  and  that  appalling  eye  inflam- 
mation which  leads  to  blindness  in  the  child.  It  has  been  esti- 
mated that  nearly  half  of  the  blindness  in  the  United  States  to- 
day had  its  origin  in  infections  at  birth.  A  scientific  physician 
knows  how  to  prevent  such  accidents  with  almost  absolute 
certainty,  but  the  ordinary  neighborhood  midwife  does  not. 

The  average  weight  of  a  white  American  baby,  at  birth,  is  seven 
and  one  quarter  pounds,  but  a  child  may  weigh  little  more  than 
six  pounds  and  still  be  perfectly  healthy.  The  twelve-pound 
baby  of  popular  tradition  is  very  rare  in  fact,  and  his  celebrity 
is  largely  due  to  inaccurate  scales  and  heavy  clothes.  A  child 
of  abnormal  size  is  not  to  be  envied,  since  he  is  usually  no  stronger 
than  a  smaller  one,  and  his  entry)  into  the  world  is  attended  by 
far  greater  hazards  and  difficulties. 

A  new-born  baby  appears  such  a  tiny  and  distorted  caricature 
of  a  human  being  that  it  is  often  difficult  to  convince  the  alarmed 
mother  that  nothing  is  wrong  with  it.  In  color  it  is  a  fiery  red, 
and  in  expression  it  is  utterly  vacuous.  Its  head  is  large  and  ob- 
long, and  there  are  spaces  between  the  soft  bones  of  its  skull  through 
which  the  movements  of  its  brain  may  be  observed.  The  oblong 
shape  of  the  head  soon  gives  way  to  rotundity,  and  the  process  re- 
quires no  artificial  aid.  The  notion  that  the  contour  of  the  skull 
may  be  modified  by  the  manner  in  which  the  child  is  laid  upon  its 
bed  has  little  basis  in  fact.  So  long  as  it  is  comfortable  and  has  a 
soft  pillow  under  it,  it  is  safe. 

An  infant's  abdomen  appears  enormous,  just  as  its  chest  appears 
small.  This  is  because  at  birth,  the  development  of  its  digestive 
apparatus  has  proceeded  much  further  than  that  of  its  respiratory 
organs.  For  a  week  or  so  its  breathing  may  be  quick  and  irregu- 
lar. Sometimes  it  will  miss  a  breath,  and  then  again  it  may 
breathe  so  fast  that  it  seems  to  be  suffocating.  Do  not  worry. 
It  is  merely  a  way  that  new-born  babies  have. 

During  its  first  week  the  child  is  apt  to  lose  its  red  color  and  be- 
come yellowish.  Many  midwives  note  this  as  a  dangerous  sign, 
and  proceed  at  once  to  dose  the  little  one  with  honey,  sulfur  and 
various  teas.  As  a  matter  of  fact,  the  yellow  color  is  nothing  more 

14 


than  the  symptom  of  a  passing  jaundice  which  disappears  in  short 
order  and  is  by  no  means  alarming.  All  babies  do  not  have  it,  but 
those  that  do,  suffer  no  damage. 

About  the  same  time  the  child's  skin  begins  to  break  up  into 
fine  scales  and  come  off,  and  its  hair — the  fine  down  on  its  body 
and  the  longer  hair  which  may  have  covered  its  head  at  birth — 
begins  to  fall  out. 

All  of  this  shedding  is  quite  normal,  and  is  a  mere  preliminary 
to  the  appearance  of  the  true,  soft,  satiny  baby  skin.  With  the 
beautiful  texture  of  the  latter  every  woman  is  familiar.  It  is 
nearly  white  on  the  body  and  limbs,  but  becomes  a  deep  rose-pink 
on  the  palms  and  soles. 

A  healthy  baby  usually  celebrates  its  advent  into  this  wicked 
world  by  setting  up  a  shrill  cry.  When  this  primal  utterance 
is  not  heard,  the  doctor  often  provokes  it  by  manipulating  the  new- 
comer's arms  and  legs,  or  even  by  treating  it  to  a  gentle  spanking. 
This  cry  is  a  good  sign,  for  it  proves  that  the  baby  has  sturdy  lungs 
and  that  it  has  promptly  discovered  their  use.  But  the  absence 
or  postponement  of  a  wail  need  arouse  no  fears,  for  plenty  of 
healthy  babies  greet  the  world  with  dignified  silence.  It  is  the 
firm  belief  of  nearly  all  midwives  that  a  child  which  cries  feebly 
or  not  at  all  during  its  first  few  minutes  of  life  is  doomed  to  ill- 
ness and  early  death.  This  belief  is  an  heirloom  from  the  age 
of  portents  and  premonitions. 

In  this  connection  it  may  be  of  interest  to  note  that  a  new-born 
baby,  no  matter  how  lustily  it  may  signify  its  discontent,  never 
sheds  tears.  This  is  because  its  lachrymal  glands,  like  many  of 
its  lesser  organs,  have  not  yet  found  their  function.  Neither  does 
it  slobber,  as  babies  of  larger  growth  are  apt  to  do,  for  its  salivary 
glands  are  still  inert,  and  its  tongue,  in  consequence,  is  white  and  dry. 

Loving  mothers  and  imaginative  aunts  are  wont  to  discover 
evidences  of  perception  and  intelligence  during  the  first  week, 
but  as  a  matter  of  fact,  a  human  infant,  until  it  is  fully  a  month 
old,  is  alive,  and  that  is  all.  Its  eyes  may  see,  but  its  brain 
cannot  understand,  and  all  of  its  acts  are  automatic  reflexes. 
Crying  constitutes  the  primitive  language  whereby  it  makes 
known  its  few  wants.  It  cries  when  it  is  hungry  and  when  it  is 
uncomfortable.  The  young  mother  will  quickly  grow  familiar 
with  its  normal  voice  and  so  learn  to  detect  variations. 

A  healthy  baby  cries  about  two  hours  a  day  for  no  other  reason 

15 


than  that  it  needs  exercise.    This  crying  is  not  continuous,  but 
is  distributed  over  the  twenty-four  hours  in  short  spells. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  II 

Should  not  the  bringing  up  of  a  child  strong  in  body  and  character 
require  as  systematic,  careful  and  scientific  study  as  any  profession? 

Yes.  Enlightened  mother-love  learns  the  most  advanced  methods 
of  caring  for  children. 

How  can  the  average  mother  get  this  knowledge? 

In  some  large  cities  and  small  towns  there  are  classes  for  young 
mothers  with  doctors  held  in  the  public  schools  or  in  the  mothers' 
clubs.  Many  health  departments  send  doctors  or  educational 
nurses  to  teach  mothers  in  their  homes  the  care  of  babies. 

What  should  a  mother  do  to  belong  to  such  a  class? 

She  should  ask  her  health  commissioner  or  school  superintendent 
whether  he  can  direct  her  to  such  a  class  or  send  a  teacher  to  her. 

When  should  a  mother  put  herself  in  the  care  of  a  doctor? 

As  soon  as  she  knows  a  baby  is  coming  to  her.  She  should  have 
a  thorough  physical  examination  and  should  consult  her  doc- 
tor frequently  to  prevent  the  dangers  that  often  attend  childbirth. 

Should  a  mother  go  to  a  hospital  for  her  confinement? 

If  the  care  of  her  home  and  children  is  heavy,  she  should  do 
so.  The  rest  and  care  of  the  hospital,  as  well  as  the  education  it 
will  give  her,  is  invaluable  to  her  and  to  her  baby. 

What  are  the  tests  she  should  use  in  selecting  her  physician? 

The  best  recommendation  for  a  physician  is  that  he  is  sought  by 
his  fellow  physicians  for  advice. 

What  should  she  do  if  she  is  in  doubt? 

She  should  go  to  her  health  department  and  ask  for  advice  in 
selecting  the  doctor  to  care  for  her  and  her  baby. 

Why  should  a  mother  never  employ  a  midwife  when  she  can  go  to  a 
doctor? 

Because  many  more  babies  who  are  brought  into  the  world  by 
midwives  die  than  babies  who  are  brought  into  the  world  by  phy- 
sicians. Because  a  midwife's  education  falls  far  below  that  of 
a  physician.  A  woman  should  sacrifice  her  own  prejudice,  and 
always  employ  a  physician.  The  best  is  not  too  good  for  her  baby. 

16 


CHAPTER  III.— BABY'S  FIRST  FEW  MONTHS 

HE  young  child  has  almost  no 'power  of  reason, 
but,  like  a  little  animal,  it  soon  learns  to  make 
a  sort  of  unconscious  correlation  between 
cause  and  effect.  That  is  to  say,  it  learns  that 
certain  acts  lead  to  certain  results.  If  its 
nurse  or  mother  stills  it  once  or  twice  by  tak- 
ing it  in  her  arms,  it  will  cry  thereafter  when- 
ft  ever  it  wants  to  be  taken  up.  In  the  same  way 
it  will  learn,  in  an  incredibly  short  time,  how  to  bring  some  one 
to  its  cradle-side  to  rock  it.  These  cries  of  habit  should  be 
promptly  suppressed,  for,  in  the  first  place,  it  is  not  good  for  a 
child  to  be  handled  or  rocked;  and  in  the  second  place,  com- 
pliance will  quickly  give  it  perverse  and  disagreeable  habits.  Let 
it  cry  for  three  nights  in  succession  and  it  will  hold  its  peace 
thereafter.  The  ancient  fear  that  a  baby  which  is  permitted  to 
yell  away,  without  effort  to  soothe  it  and  still  it,  will  rupture  itself, 
is  groundless.  A  baby  lying  upon  a  soft  pillow  cannot  possibly 
rupture  itself,  no  matter  how  violently  it  cries  or  how  vigorously  it 
tosses  about. 

The  cry  of  habit  iis  much  like  the  normal  cry  of  every  baby. 
The  wails  are  long  drawn  out  and  have  a  sort  of  rising  and  falling 
cadence.  They  are  still  at  once  if  the  baby  gets  what  it  wants.  If 
it  does  not,  they  gradually  grow  less  loud  and  so  cease. 

The  cry  of  pain,  on  the  contrary,  is  a  short,  quick,  gasping  cry. 
The  baby  commonly  draws  up  its  legs  and  gives  other  evidences  of 
serious  disturbance.  Mild  colic,  which  is  not  dangerous,  often  pro- 
duces this  cry.  Unless  it  is  prolonged  there  is  no  need  to  be  alarmed. 
The  prudent  nurse,  however,  will  make  a  diligent  search  for 
tight  napkins  and  loose  pins. 

The  cry  of  hunger  is  a  quick,  sharp,  staccato  cry,  with  high, 
shrill  notes,  but  less  vigorous  than  the  cry  of  pain.  It  should  cease 
at  once  on  feeding. 

The  cry  of  temper — and  temper  is  exhibited  by  very  young  chil- 

17 


ctren — is  long,  sharp,  and  high-pitched.  It  indicates  that  the 
youngster  is  enraged — that  it  wants  more  light  in  the  room,  that  its 
bed  is  uncomfortable,  that  it  wants  some  one  to  change  its  posi- 
tion, or  that  it  does  not  want  the  food  forced  upon  it.  Some  children 
have  such  violent  tempers  that  they  throw  back  their  heads  and  grow 
blue  in  the  face  and  seem  to  cease  breathing.  The  mother  often 
fancies  that  they  are  in  convulsions  and  sends  for  the  doctor  post- 
haste. The  best  way  to  deal  with  such  recalcitrant  little  folks  is  to 
lay  them  in  bed  and  let  them  cry.  They  will  quickly  observe  the 
futility  of  their  efforts  and  so  cease. 

When  children  grow  older  they  acquire  what  might  be  called  the 
"insulted  "  cry.  A  child  of  six  months  is  sensitive  to  sharp  words 
and  gives  voice  to  the  humiliation  they  produce.  This  cry  consists 
of  a  short  sob,  followed  by  a  longer  one,  and  slowly  rising  in  volume, 
though  not  in  pitch.  Indeed,  it  is  not  unlike  the  cry  of  a  woman. 

The  cries  of  pain,  hunger  and  temper  are  accompanied  by  a 
drawing  up  of  the  legs.  In  the  other  cries  the  child's  limbs  have 
no  part. 

Babies  change  so  much  during  their  first  few  weeks  that  their 
appearance  at  birth  gives  no  hint  as  to  their  future  complexion,  form 
or  stature.  One  may  come  into  the  world  with  its  mother's  blue 
eyes  and  small  nose,  and  attain  its  majority,  twenty-one  years  later 
with  the  darker  orbs  and  more  formidable  nose  of  its  father. 
This  is  because  nearly  all  babies  have  eyes  of  an  indefinite,  bluish 
color,  and  noses  of  no  particular  shape  at  all.  The  color  of  their 
hair,  if  they  have  any,  is  also  misleading,  for,  as  a  general  thing,  it 
is  considerably  lighter  than  it  will  be  in  after  years. 

During  its  first  month  a  baby  has  almost  no  control  over  its 
muscles.  If  you  lay  it  down,  it  remains  just  where  you  put  it  and 
cannot  change  its  position.  If  you  hold  it  up,  its  head  rolls  about. 
In  nursing,  its  movements  are  entirely  automatic  and  unconscious — 
as  much  so,  indeed,  as  those  of  the  minute  organisms  which  bridge 
the  border-line  between  plants  and  animals.  There  is  good  reason 
to  doubt,  indeed,  that  it  is  conscious  of  pain.  Its  cry  appears  as  a 
mere  reflex  and  without  the  interposition  of  cognition  or  effort. 

But  this  stage  does  not  last  long,  for  a  baby  grows  with  remarkable 
rapidity.  The  rate  at  which  it  lives  is  well  demonstrated  by  ob- 
serving the  functioning  of  its  organs.  Its  heart  beats  at  a  rate  that 
would  be  fatal  to  an  adult,  and,  as  we  have  seen,  it  breathes  very 
fast.  At  birth,  for  example,  its  pulse  is  often  one  hundred  and  for- 

18 


ty-five  a  minute,  which  is  just  twice  the  normal  rate  in  a  grown  man 
or  woman.  Its  respiration  is  similarly  hurried,  being  forty-five 
or  more  a  minute  for  the  first  few  weeks,  as  against  sixteen  to  eight- 
een in  the  adult.  The  bowels  of  a  new-born  baby  are  usually 
very  active,  but  the  bladder  may  not  function  until  after  its  first 
day. 

By  the  time  it  is  four  months  old  the  child  weighs  almost  twice 
as  much  as  it  did  at  birth  and  is  plainly  making  rapid  progress.  It 
can  now  hold  up  its  head  'without  support,  and  it  has  developed  a 
habit  of  grasping  any  small  objects  which  touch  its  hands.  Be- 
fore it  is  a  month  old  it  may  smile,  but  it  is  not  until  some 
time  later  that  its  smile  seems  to  be  associated  with  any  definite 
idea.  But  by  the  time  it  enters  upon  its  fourth  month  its  intel- 
ligence is  fully  dawning.  It  learns  to  recognize  its  mother,  and 
ceases  to  cry  when  she  takes  it  in  her  arms.  Its  eyes  follow  lights 
and  moving  objects  and  its  ears  detect  noises. 

Soon  afterwards  it  begins  to  distinguish  between  its  mother  and 
other  persons  and  to  become  fully  conscious  of  the  world  about  it. 

A  baby  begins  to  utter  sounds  other  than  those  of  crying  when 
very  young,  and  before  it  is  six  months  old  it  often  acquires  a  vo- 
cabulary of  three  or  four  vowels.  The  first  that  it  masters  is 
commonly  the  broad  "a,"  and  this  diligently  repeated,  as  "ah- 
ah-ah-ah, "  convinces  its  mother  that  it  has  learned  to  say  "mama." 
But,  as  a  matter  of  fact,  the  youngster  is  merely  voicing,  with  the 
one  elementary  sound  at  its  command,  its  general  feeling  of  comfort. 
This  "ah-ah, "  indeed,  is  a  brother  to  the  purr  of  the  house-cat  upon 
the  hearth-rug,  and  is  similarly  devoid  of  any  underlying  con- 
cept. 

Soon,  however,  a  multitude  of  crude  but  vastly  interesting  ideas 
throng  the  infantile  brain,  and  the  baby  tries  to  talk.  Some  babies 
make  such  efforts  as  early  as  the  ninth  month,  but  others  are  much 
slower.  The  fact  that  a  child  is  backward  in  talking  is  no  sign  of 
defective  intelligence,  nor  does  it  prove  that  it  will  be  a  slow  pupil 
later  on.  Some  of  the  greatest  men  of  genius  the  world  has  known 
were  unable  to  form  intelligible  words  until  the  age  of  two  years. 

In  the  matter  of  walking  and  teething  there  is  the  same  unac- 
countable variation.  Some  babies  are  able  to  sit  up  at  the  age 
of  six  months  and  begin  to  make  efforts  to  crawl  at  the  same  time. 
Held  upright  on  its  feet,  a  youngster  of  such  precocity  will  try 
to  stand  erect,  and  will  crow  with  delight  if  it  succeeds.  There 

19 


are  babies,  equally  intelligent  and  healthy,  which  seem  to  be  hope- 
lessly clumsy  and  are  utterly  unable  to  make  the  crudest  approach 
to  locomotion.  As  a  general  thing,  a  baby  which  begins  to  walk 
at  sixteen  months  is  doing  well  enough.  Plenty  of  children  try 
in  vain  until  after  they  are  two  years  old.  If  the  baby's  legs  are 
strong  and  it  is  in  good  health  there  is  no  reason  why  backwardness 
in  this  respect  should  cause  alarm.  The  various  mechanical  con- 
trivances for  teaching  children  to  walk — rolling  chairs,  frames,  etc. 
— are  of  questionable  utility  and  may  produce  dangerous  strains 
upon  the  weak  bones  and  muscles. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  III 

What  are  some  of  the  habits  a  young  baby  should  be  taught  to  form? 

It  should  be  nursed  at  regular  intervals. 

It  should  be  fed,  bathed,  dressed  and  put  to  bed  at  the  same 
hours  each  day. 

It  should  be  allowed  to  sleep  most  of  the  day  and  night  except 
when  it  is  time  to  be  fed  or  to  be  bathed. 

Is  should  be  taught  to  eliminate  its  food  at  regular  hours.  There 
is  no  need  for  the  disagreeable  and  unhealthy  custom  of  soiled 
diapers.  If  you  hold  the  child  on  its  little  "chair"  once  an  hour, 
you  will  help  it  form  clean  habits  that  will  prevent  constipation, 

Need  a  baby  always  wear  flannel  next  the  skin? 

A  baby  should  be  dressed  according  to  the  weather.  It  should 
never  be  allowed  to  get  chilled.  It  should  never  be  allowed  to 
get  into  a  perspiration,  for  its  body  is  apt  to  become  chilled.  A 
baby's  little  body  will  become  chilled  or  heated  quicker  than  an 
adult's.  Keep  its  hands  and  feet  warm  in  winter  and  dress  it  very 
lightly  in  summer. 

Should  a  baby  wear  long  clothes? 

If  it  is  born  in  the  cold  weather,  it  may  wear  long  clothes  for  the 
first  few  months,  but  they  must  not  be  long  enough  to  be  heavy 
and  drag  on  the  child's  shoulders.  If  it  is  born  in  the  warm 
weather,  it  should  wear  dresses  not  below  its  feet. 

What  should  a  mother  remember  about  her  baby's  clothes? 

She  should  put  herself  in  the  baby's  place.  She  should  remem- 
ber that  its  skin  is  very  tender  and  that  buttons,  pins,  wrinkles 
hurt  it,  make  it  restless,  uncomfortable  and  fretful. 

20 


CHAPTER  IV.— THE  NURSING  BABY 

HUMAN  infant,  during  the  first  few  months 
of  its  life,  is  an  extremely  delicate  organism, 
and  so  it  should  be  handled  with  care,  which 
means  that  it  should  be  handled  as  seldom  as 
possible.  The  young  mother  who,  in  the  excess 
of  her  pride  and  love,  cuddles  her  baby  to  her 
breast  and  showers  kisses  upon  it  by  the  half- 
hour  makes  a  pretty  picture,  it  must  be 
admitted,  but  it  cannot  be  maintained  that  the  little  one  is 
benefited  by  her  caresses.  Quite  to  the  contrary,  her  every  kiss 
helps  to  make  it  nervous  and  irritable  and  prepares  the  way  for 
the  seeds  of  disease.  A  baby  that  is  fondled  too  much  is  a  baby 
that  cries  too  much,  and  is  ill  too  much. 

Despite  the  evidences  of  intelligence  apparent  to  loving  eyes 
after  the  first  week,  an  infant's  mind  is  a  happy  blank,  and  it  gets 
no  joy  out  of  the  affections.  To  it,  its  mother  appears  merely  as 
a  source  of  food,  and  later  on,  when  its  brain  begins  to  function, 
this  primitive  association  of  a  craving  and  the  means  of  satisfaction 
is  probably  the  first  definite  idea  that  formulates  in  its  mind.  When 
it  is  hungry,  it  wants  its  mother  to  feed  it,  and  before  long,  in- 
stead of  merely  crying  for  food,  it  cries  for  her. 

When  it  is  not  hungry,  its  chief  need  and  desire  is  for  sleep.  A 
healthy  baby,  during  its  first  month,  should  sleep  at  least  eighteen 
hours  a  day.  And  this  sleeping  should  be  done,  not  in  a  rocking, 
nerve-racking  cradle,  but  in  a  solid,  comfortable  crib.  The  cradle 
belongs  to  the  age  of  spinning-wheels  and  flails,  of  soothing  syrups 
and  necromancy. 

It  is  not  until  the  fourth  day  after  the  baby's  birth  that  its  mother's 
milk  is  truly  nourishing,  but  such  as  it  is,  it  exactly  meets  the  needs 
of  the  child.  It  is,  in  fact,  a  sort  of  laxative  serum,  which  stimu- 
lates the  entire  digestive  tract  and  prepares  the  stomach  for  the 
reception  of  food.  On  the  first  day  the  baby  should  be  nursed  only 
once,  but  it  should  be  given  a  drink  of  boiled  water  every  three 


hours  or  so.  On  the  second  day  it  should  be  nursed  three  times — 
morning,  afternoon  and  night — with  the  same  allowance  of  water. 
On  the  third  day  the  routine  of  the  second  day  should  be  repeated. 
At  the  end  of  the  third  day  it  will  be  found  that  the  child  has  lost 
a  quarter  or  half  a  pound.  This  need  cause  no  alarm,  for  it  is  per- 
fectly natural,  and  a  steady  gain  will  immediately  begin. 

On  the  fourth  day  both  baby  and  mother  are  ready  for  regular 
feedings  at  shorter  intervals.  From  this  time  onward,  until  to- 
ward the  end  of  its  second  month,  the  child  should  be  nursed  every 
two  hours,  with  a  slightly  longer  wait  after  its  daily  bath,  and  an 
interval  of  seven  hours  in  the  night.  In  all,  it  should  have  about 
nine  feedings  during  the  twenty-four  hours,  as  follows:  6,  8  and 
10  A.  M.  and  1,  3,  5,  7,  9  and  11  P.  M.  Between  eleven  o'clock  in 
the  evening  and  six  in  the  morning  it  should  not  be  fed  at  all. 
The  fact  that  most  babies  demand  food  during  this  time  merely 
shows  that  most  babies  have  bad  habits.  Let  the  child  cry  in  vain 
for  three  nights  running  and  it  will  never  cry  again.  But  during 
the  day,  even  if  it  happens  to  be  sound  asleep,  it  is  well  to  waken  it 
in  order  to  keep  to  this  schedule  faithfully. 

The  bath  should  be  given  just  before  the  ten  o'clock  feeding  in  the 
morning.  The  water  should  be  at  the  temperature  of  the  body — 
about  99  degrees — and  soap  should  be  used  very  sparingly.  After 
the  child  has  been  gently  washed,  sponge  it  with  a  soft  cloth  dipped 
in  cold  water  and  give  it  a  brief  rub-down  with  alcohol.  This  will 
bring  the  blood  to  the  surface,  stimulate  the  circulation  and  pre- 
vent colds.  It  is  well  to  let  the  baby  sleep  three  or  four  hours  after 
its  bath.  Then,  if  it  has  not  already  awakened  and  demanded 
food,  it  should  be  aroused  and  the  regular  schedule  of  feeding  re- 
sumed. 

The  length  of  time  that  the  child  should  be  kept  at  the  breast  at 
each  feeding  depends  so  much  upon  the  volume  of  the  milk  and  its 
own  idiosyncrasies  that  it  is  impossible  to  lay  down  an  invariable 
rule.  The  mother  should  be  guided  by  the  fact  that  a  newly-born 
infant's  stomach  has  a  capacity  of  but  one  ounce,  or  eight  teaspoon- 
fuls.  Some  babies  are  able  to  ingest  this  amount  of  milk  in  a  few 
minutes,  while  others  require  much  longer.  But  it  is  rarely  safe  to 
keep  a  child  at  the  breast  for  more  than  from  ten  to  fifteen  minutes. 

An  infant's  stomach  is  not  a  fully  developed  organ,  and,  as  every 
one  knows,  it  can  digest  only  milk,  or  something  closely  approxi- 
mating milk  in  composition.  As  a  matter  of  fact,  it  probably  plays 

22 


but  a  minor  role  even  in  the  digestion  of  milk,  for  it  stands  almost 
perpendicular  and  is  really  little  more  than  an  extension  of  the  bow- 
els. The  food  which  enters  it  passes  into  the  bowels  very  quickly, 
and  there  the  more  important  part  of  the  process  of  digestion  takes 
place.  But,  all  the  same,  a  baby  should  be  given  no  more  food 
than  its  stomach  can  hold. 

A  baby,  like  an  adult,  needs  water  as  regularly  as  it  needs  food. 
The  milk  that  it  gets,  though  a  liquid,  does  not  satisfy  its  thirst. 
It  should  be  given  water  at  least  three  times  a  day,  and  this  water 
should  be  nearly,  if  not  quite,  free  of  organisms.  The  water  that 
comes  from  the  average  city  main  or  country  spring  is  alive  with 
microscopic  plants  and  animals,  even  when  it  seems  clear  and 
sparkling.  These  minute  organisms,  as  a  rule,  are  harmless  to 
adults,  but  in  the  delicate  stomach  of  the  baby  they  are  apt  to 
cause  disturbances,  and  so  they  must  be  eliminated.  The  best 
way  to  get  rid  of  them  is  to  allow  the  water  to  boil  twenty  minutes. 
After  that,  let  it  cool  and  store  it  in  clean,  well-corked  bottles  which 
have  been  previously  immersed  in  boiling  water  for  five  minutes. 
Glass  stoppers  are  better  than  corks. 

Boiled  water  is  tasteless  and  insipid  because  of  the  absence  of 
air-bubbles,  but  the  baby  seldom  notices  it.  It  is  best  drunk  out  of  a 
thoroughly  clean  nursing-bottle.  Offer  water  to  the  infant  every 
four  hours,  and  let  it  drink  as  much  as  it  wants.  The  supply  for 
each  day  should  be  boiled  in  the  morning.  Under  no  circum- 
stances should  water  be  kept  more  than  a  day. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  IV 

Who  should  kiss  your  baby? 

Nobody  should  kiss  it  on  the  mouth,  not  even  you.  You  should 
instruct  every  one  who  is  likely  to  come  in  contact  with  it  to  kiss 
it  on  its  cheek  or  forehead.  Instruct  your  nurse  not  to  let  strangers 
kiss  the  baby.  A  consumptive's  kiss  might  give  it  tuberculosis. 

How  much  should  your  baby  sleep? 

A  heal  thy  infant  should  sleep  most  of  the  time  except  feeding  time. 

Should  any  attempt  be  made  to  develop  a  young  baby's  mind? 

No.  A  baby  should  not  even  be  played  with,  or  in  any  way 
excited.  This  makes  it  nervous  and  gives  it  indigestion.  Remem- 
ber, much  joy  as  your  baby  gives  you,  it  should  never  be  made 

23 


to  give  you,  your  family,  or  friends,  entertainment  at  the  sacri- 
fice of  its  own  health  and  regular  habits. 

How  should  a  baby  be  put  to  bed  in  the  day  time? 

A  baby  should  always  sleep  alone.  It  must  have  a  little  bed  of 
its  own.  Not  a  cradle,  but  a  crib  with  a  flat  mattress  and  a  low 
pillow  or  no  pillow.  The  baby  should  be  put  to  sleep  on  a  shaded 
piazza,  or  yard,  or  in  a  room  with  the  windows  open.  Its  covers 
should  be  suited  to  the  temperature  of  the  day.  It  should  never 
be  allowed  to  become  chilled  or  to  perspire.  In  cold  weather  the 
sun  should  shine  on  its  bed  but  never  in  the  child's  eyes. 

What  is  meant  by  being  ''regular"  with  the  baby? 

That  it  should  be  fed  at  the  same  hours  every  day — bathed  at 
the  same  hour  every  day — put  to  sleep  at  the  same  hour  and  taken 
up  at  the  same  hour.  That  its  bowels  should  move  at  the  same 
hours — that  it  should  not  be  fed  whenever  it  cries — not  to  be  taken 
up  to  entertain  visitors —that  it  should  be  expected  to  sleep  all 
night  without  feeding  or  petting. 

How  often  should  the  baby  be  bathed? 

The  baby  should  be  bathed  every  day  before  the  ten  o'clock  feed- 
ing. Everything  necessary  to  the  bath  should  be  in  readiness  before 
the  baby  is  undressed.  Hang  up  a  list  of  the  necessary  articles  in 
the  bathroom  and  consult  it  every  day.  The  baby  may  get  chilled 
while  you  are  hunting  up  something  you  have  forgotten. 

LIST 

Tub — warm  water— bath-room  thermometer — soap — gauze — 
cotton  wads  in  covered  glass — powder — vaseline — flannel  apron 
towel — gauze  towels — clean  clothes  and  diaper — alcohol.  So- 
lution of  boracic  acid  in  covered  glass. 

How  should  the  bath  63  given? 

Let  the  room  be  thoroughly  warm  before  you  undress  the  baby. 
Be  sure  there  is  no  cold  air  on  its  little  body. 

Wash  the  baby's  eyes  and  mouth  with  a  swab  of  aseptic  cot- 
ton dipped  in  a  weak  solution  of  boracic  acid.  Wind  up  a  little 
wad  of  cotton  and  clean  its  ears.  Dip  a  wad  of  cotton  in  vaseline 
to  cleanse  its  nose.  Never  stick  anything  hard  into  a  child's  ears 
or  nose,  and  be  careful  not  to  leave  any  cotton  in  the  ears  or  nose. 
A  baby's  membranes  are  very  easily  injured. 

Then  put  the  child  into  a  tub  of  warm  water  and  wash  it  all  over 
with  a  mild  soap.  Teach  the  baby  to  enjoy  the  bath.  Let  it  splash 

24 


about  and  have  fun.  It  will  save  you  much  trouble.  Never  pro- 
long the  bath  to  please  the  baby  or  to  entertain  friends.  Do  not 
let  people  go  in  and  out  of  the  room  while  the  baby  is  undressed. 
Use  for  a  wash  rag  a  piece  of  aseptic  gauze,  or  bleached  cheese 
cloth,  boiled.  A  sponge  catches  and  develops  germs.  It  is  un- 
clean as  it  cannot  be  boiled  without  ruining  it.  Complete  the  bath 
with  all  dispatch.  Wrap  the  baby  in  a  woolen  blanket  to  absorb 
the  moisture  quickly.  Powder  it  with  soft  powder,  dress  it  and  feed 
it  and  put  it  at  once  to  sleep  in  the  air. 


CHAPTER  V.— MOTHER  AND  BABY 

HE  nursing-bottle  and  nipple,  whether  used  for 
water  or  for  artificial  food,  should  be  immersed 
in  boiling  water  for  at  least  five  minutes  every 
day,  and  when  they  are  not  in  use  they 
should  be  kept  in  a  covered  glass  filled  with  a 
weak  solution  of  boracic  acid.  Such  a  so- 
lution is  of  constant  usefulness  in  the  nursery, 
and  it  is  well  to  prepare  it  in  bulk.  A  cupful 
of  boracic  acid,  to  be  had  at  any  drug  store,  will  suffice  for 
two  gallons  of  water.  Keep  it  well  covered  and  it  will  last  for 
a  long  while.  Use  it  to  wash  all  dishes,  cups,  bottles,  spoons  and 
other  utensils  that  play  a  part  in  the  baby's  commissariat. 

The  best  possible  food  for  a  baby  is  mother's  milk,  and  this  is 
what  it  should  get  whenever  possible.  The  mother  who  permits 
social  "  duties, ' '  laziness  or  any  other  such  excuse  or  motive  to  in- 
terfere with  her  highest  of  privileges  is  a  woman  unfit  to  bring  human 
beings  into  the  world.  The  best  of  all  infant  foods,  like  the  best  of 
all  varieties  of  modified  cow's  milk,  is  but  a  sorry  substitute  for 
mother's  milk.  Nothing  devised  by  the  ingenuity  of  physicians  and 
chemists  can  so  perfectly  combine  the  offices  of  food,  drink  and 
medicine  as  does  this  natural  food. 

When  I  say  medicine,  I  speak  literally,  for  mother's  milk  gives 
to  the  baby  some  measure  of  her  own  acquired  power  of  resistance 
to  disease.  There  is,  indeed,  good  ground  for  the  old  saying  that, 
so  long  as  a  child  is  at  the  breast,  the  blood  of  its  mother  continues 
to  flow  through  its  veins.  Recent  investigation  in  susceptibility 
and  immunity  have  shown  that  this  is  true,  at  least  in  effect,  for 
the  breast-fed  child  shows  a  distinctly  greater  capacity  for  re- 
sisting the  organisms  of  all  the  principal  infectious  diseases  than 
the  child  fed  upon  artificial  food.  To  put  it  simply,  the  baby  nursed 
by  its  mother  is  far  less  likely  to  take  measles,  scarlet  fever  or 
chicken-pox,  and  far  more  likely  to  recover  quickly  and  completely 
if  it  does,  than  the  baby  nourished  by  cow's  milk  and  cereals. 

26 


Unfortunately,  contingencies  sometimes  arise  which  make  it 
unwise  or  impossible  for  the  mother  to  nurse  her  child.  It  may 
happen,  for  instance,  that  the  former  is  suffering  from  some  in- 
fectious disease,  such  as  tuberculosis.  Under  such  circumstances, 
nursing  is  out  of  the  question,  for,  besides  its  dangerous  effect  upon 
the  health  of  the  mother,  it  is  also  apt  to  bring  disaster  to  the  baby. 

The  child  of  a  consumptive  mother  should  be  taken  from  her  at 
once  and  brought  up  away  from  her.  She  has  a  battle  for  life  ahead 
of  her  which  will  consume  all  of  her  available  energies,  and  the 
child,  too,  has  a  serious  but  not  hopeless  battle  against  inherited 
predisposition.  An  infant  is  ill-fitted  to  breathe  the  air  of  a  con- 
sumptive's sick-room,  and  an  impulsive  kiss  may  doom  it  to  long 
suffering — with  "spine  disease,"  for  example,  a  frequent  form  of 
tuberculosis  in  children — and  an  early  death. 

Any  other  sort  of  serious  illness  is  sufficient  ground  for  weaning 
the  child  at  once.  There  are  also  other  conditions  which  make  it 
impossible,  however  good  her  intentions,  for  a  mother  to  nurse 
her  child. 

Even  while  she  is  nursing  her  child,  some  physical  or  mental 
disturbance  may  interfere,  temporarily,  with  a  mother's  supply  of 
milk.  Household  cares  are  often  responsible  for  these  difficulties, 
which  show  themselves  in  a  scanty  supply  or  in  illness  in  the  child. 
The  mother  who  has  half  a  dozen  other  children  to  care  for  and  a 
house  to  look  after  is  not  capable  of  providing  her  baby  with  the 
nourishment  it  needs.  During  the  nursing  period  she  should  be 
relieved  as  much  as  possible  of  domestic  cares.  Needless  to  say, 
she  should  avoid  all  excitement  of  whatever  sort.  Giving  a  dinner- 
party is  almost  as  costly  to  her  strength  as  a  fit  of  passion  or  a  severe 
fright,  and  either  may  cause  the  supply  of  milk  to  cease  or  render 
it  unfit  for  the  baby's  stomach.  Severe  intestinal  disturbances 
in  nursing  children  are  often  caused  by  maternal  imprudences. 

The  nursing  mother  should  eat  plenty  of  simple^  nourishing 
food,  and  avoid  all  stimulants.  Alcohol,  in  particular,  is  to  be 
held  in  abomination.  She  should  eat  meat  sparingly,  and  should 
make  eggs  and  vegetables  her  chief  articles,  of  diet.  Let  her  drink 
milk  freely,  and  avoid  coffee  and  tea.  Of  raw  fruit  she  had  better 
be  wary,  but  plenty  of  cooked  fruit  will  help  to  keep  her  well. 
Needless  to  say,  she  must  pay  quick  heed  to  all  minor  illnesses, 
particularly  disturbances  in  the  digestive  tract. 

Young  mothers  are  prone  to  take  an  unsafe  pride  in   getting 

27 


about  as  soon  as  possible  after  their  babies  are  born.  This  ambition, 
it  is  plain,  deserves  no  encouragement.  The  average  American 
woman,  especially  in  the  large  cities,  is  far  from  perfect  phys- 
ically, and  so  it  is  well  for  her  to  be  extremely  prudent.  But  at  the 
end  of  three  weeks  it  is  usually  safe  for  her  to  take  a  short  drive 
or  shorter  walk.  As  her  strength  grows  she  should  begin  regular 
daily  exercise,  preferably  walking.  Let  her  keep  the  windows  of 
her  room  open,  and  remain  in  the  open  air  as  much  as  possible. 
She  needs  eight  hours  of  sleep  in  the  twenty-four,  at  the  very  least. 

When  it  becomes  impossible  for  a  mother  to  nurse  her  child, 
two  courses  are  open:  either  the  baby  may  be  handed  over  to  a 
wet-nurse,  or  some  effort  may  be  made  to  nourish  it  with  arti- 
ficial foods  or  modified  cow's  milk. 

Wet-nurses,  at  their  best,  are  unsatisfactory,  and  at  their  worst 
they  are  exceedingly  dangerous.  One  of  them  may  submit  her- 
self to  the  scrutiny  of  careful  physicians  and  pass  them  as  perfectly 
sound,  and  yet  be  suffering,  all  the  while,  from  a  communicable 
malady.  Taken  as  a  class,  they  are  ignorant,  careless  and  unclean. 
Setting  aside  the  cocasional  gem  among  them,  they  seldom  pro- 
vide their  charges  with  nourishment  as  wholesome  as  that  to  be 
had  from  the  milk  laboratorv. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  V 

What  should  a  baby  be  fed? 

For  the  first  few  months,  its  mother's  milk  is  the  only  food  that 
should  be  given  to  the  baby. 

The  baby  should  have  water  three  times  a  day,  every  four  hours, 
between  feedings.  It  should  be  boiled  and  cooled  and  given  in  a 
nursing  bottle  that  has  been  boiled,  or  with  a  spoon. 

How  can  a  mother  keep  her  milk  in  good  condition  so  that  it  will 
nourish  the  baby? 

She  should  eat  three  plain  well-cooked  meals  a  day  at  regular 
hours.  She  should  drink  water  between  meals.  Keep  her  bowels 
regular — constipation  in  a  nursing  mother  often  causes  colic  in 
her  baby.  The  baby's  health  is  dependent  upon  the  mother's 
health.  Often  when  it  seems  as  if  the  baby  must  be  put  on  art- 
ificial food,  by  building  up  the  mother's  health  her  milk  is  improved 
and  the  baby  thrives  on  it. 

28 


What  may  make  a  mother's  milk  poor? 

Lack  of  rest  and  nervousness.  Not  enough  nourishing  food. 
Constipation. 

What  is  the  mistake  most  mothers  of  young  babies  make? 

They  try  to  do  too  much.  They  should  stay  in  bed  at  least  three 
weeks  after  the  birth  of  a  baby,  and  should  cultivate  the  habit  of 
resting  as  much  as  possible  before  the  birth  and  during  the  nursing 
period.-  It  should  be  a  happy,  restful  time  when  sleep,  food  and 
exercise  are  abundant.  To  make  it  so  is  the  duty  of  a  mother. 
It  is  far  more  important  for  the  future  of  her  family  than  are  the 
many  things  she  wears  out  her  strength  doing. 

Why  is  nursing  so  essential  to  a  baby's  future  health? 

Because  mother's  milk  is  the  natural  food.  It  gives  the  child 
the  immunity  of  its  parent.  It  aids  the  mother  by  reflexly 
strengthening  her  internal  organs.  A  child  will  grow  and  thrive 
on  cow's  milk,  but  it  has  twice  as  many  chances  to  reach 
maturity  when  breast-fed. 


CHAPTER  VI.— THE  BOTTLE-FED  BABY 

EXT  to  mother's  milk,  the  best  of  all  available 
foods  for  human  infants  is  cow's  milk.  I 
say  "best,"  but  in  this  connection  the  word  is 
almost  meaningless,  for  the  difference  between 
mother's  milk  and  cow's  milk  is  great.  The 
first  is  at  once  a  perfect  food  and  an  efficient 
medicine,  while  the  second  is  a  very  unsatis- 
factory  food  and  no  medicine  at  all.  That  is 
why  a  child  fed  at  the  breast,  all  other  things  being  equal,  has 
just  about  twice  as  many  chances  of  growing  up  healthy  and 
sturdy  as  a  child  fed  from  a  bottle.  Bottle  food,  no  matter  how 
carefully  it  may  be  prepared,  is  a  mere  substitute  and,  like  all 
substitutes,  it  is  likely  to  be  dangerous. 

The  chief  superiority  of  mother's  milk  lies  in  the  fact  that  it 
contains  all  of  the  nutritive  elements  needed  by  the  baby,  in  pre- 
cisely the  right  proportions — and  nothing  else.  It  is  easy  enough 
to  prepare  an  artificial  food  that  contains  one  or  more  of  these 
elements,  but  no  man  has  yet  invented  one  that  contains  all  of 
them.  Again,  it  is  impossible  to  rid  artificial  foods  of  certain 
things  whose  presence  in  the  infantile  digestive  tract  causes  trouble. 
Some  of  these  things  are  merely  superfluous,  but  others  are  often 
indistinguishable  from  poisons. 

Saving  only  the  milk  sugars  and  the  water,  not  one  of  the  im- 
portant constituents  of  mother's  milk  is  exactly  duplicated  in  cow's 
milk.  Consider,  for  instance,  the  difference  between  the  caseins 
of  the  two.  To  understand  it,  one  must  remember  that  a  casein  is 
made  up  of  proteids  and  that  proteids  constitute  the  most  im- 
portant of  all  elements  of  human  nourishment.  The  albumen 
found  in  the  white  of  an  egg  is  a  proteid,  and  the  lean  part  of  meat 
is  heavy  with  proteids. 

Well,  all  proteids,  when  they  reach  the  stomach,  begin  to  clot, 
just  as  the  albumen  in  an  egg  coagulates  when  the  egg  is  heated. 
The  proteids  in  mother's  milk  and  in  cow's  milk  clot  in  just  this 

30 


way,  but  what  a  difference  in  the  manner  of  their  clotting!  Those 
of  mother's  milk  clot  into  fine  flakes,  which  remain  separate  and 
are  easily  attacked  by  the  secretions  of  the  baby's  stomach,  and 
so  start  at  once  upon  their  metamorphosis  into  blood.  But  those 
of  cow's  milk  clot  into  large,  tough  lumps,  with  which  the  baby's 
stomach  struggles  in  vain. 

The  result  is  that  mother's  milk  is  digested  easily  and  rapidly, 
while  cow's  milk  is  digested  only  with  difficulty,  and  sometimes  not 
at  all.  This  fact  explains  the  frequent  colics,  vomiting,  diarrhea 
and  other  forms  of  indigestion. 

Again,  cow's  milk  contains  nearly  three  times  as  much  casein, 
proportionately,  as  mother's  milk,  and  in  consequence  the  child 
who  ingests  it  undiluted  is  overfed.  This  helps  to  burden  the  har- 
assed stomach  and  makes  the  disorder  more  violent  and  more 
frequent. 

There  are  similar  differences  between  all  the  other  constituents 
of  mother's  milk  and  cow's  milk,  particularly  the  acids,  but  they  are 
understandable  only  to  physicians  and  chemists.  More  apparent 
and  more  important  is  the  fact  that  cow's  milk,  as  it  is  received  from 
the  dairyman,  is  alive  with  a  multitude  of  germs  that  are  never 
found  in  mother's  milk.  There  is  no  doubt  that,  if  the  latter  were 
stored  in  vessels  and  transported  long  distances  before  being  fed 
to  babies,  it  would  be  just  as  bad,  but  every  one  knows  that  it  is 
never  so  stored  and  transported.  It  reaches  the  baby's  stomach 
warm  and  fresh  and  without  exposure  to  the  air,  and  so  it  is  always 
clean  and  pure. 

When  a  cow  is  milked  the  milk  takes  up  floating  germs  from  the 
air  through  which  it  passes  in  its  descent  to  the  can,  just  as  the 
rain-drops  of  a  Summer  shower  take  up  "the  gay  motes  that  dance 
along  a  sunbeam."  These  germs,  finding  the  milk  a  fertile  soil, 
begin  to  multiply  at  once  and  with  enormous  rapidity.  According 
to  some  observers,  the  process  begins  within  thirty  seconds.  If 
the  can  is  unclean,  or  has  been  washed  with  contaminated  water, 
if  the  milkman  has  dirty  hands,  or  if  the  cow  itself  is  infected  with 
tuberculosis  or  any  other  infectious  disease,  other  and  more  viru- 
lent germs  reenforce  those  of  the  air,  and  before  long  the  innocent- 
appearing  can  of  fresh  milk  is  swarming  with  organisms. 

It  is  impossible  to  stamp  out  these  germs  entirely,  but  proper 
handling  of  the  milk  greatly  reduces  their  number.  This  proper 
handling  looks  to  two  things — a  constant  low  temperature,  and 

31 


absolute  cleanliness.  The  milk  must  be  cooled,  and  it  must  be 
kept  cool  until  it  is  used.  Again,  it  must  be  transported,  not  in 
open  cans,  but  in  air-tight  bottles.  In  practically  every  American 
city  milk  is  sold  in  just  such  bottles. 

Once  free  of  germs,  or  reasonably  so,  cow's  milk  is  still  unfit  to 
be  fed  to  the  baby,  for  its  proteids,  sugar,  fats  and  acids  are  yet 
present  in  improper  proportions.  It  has,  for  instance,  certain 
strange  acids,  and  these  must  be  neutralized. 

I  desire  to  impress  upon  all  mothers,  the  desirability  of  seeking 
advice  from  a  good  physician  whenever  it  becomes  necessary  to 
take  the  baby  from  the  breast.  Only  a  doctor  can  accurately  de- 
termine the  needs  of  a  given  child. 

In  most  cities  there  are  milk  laboratories  which  make  a  business 
of  modifying  cow's  milk  upon  prescription.  The  physician,  know- 
ing the  child's  peculiar  requirements,  decides  just  how  much  casein, 
sugar  and  fats  should  enter  into  each  quart  of  milk  that  it  in- 
gests, and  the  laboratory  prepares  a  milk  containing  these  things 
in  exactly  the  right  proportions.  Such  milk  may  be  prepared  at 
home  by  the  mother  under  a  physician's  direction. 

Until  it  is  six  months  old  the  bottle-fed  baby  should  take  nothing 
but  modified  milk  and  boiled  water  into  its  stomach.  It  should  be  fed 
according  to  the  schedule  I  have  laid  down  for  breast-fed  children, 
and  should  get  just  as  much  water.  The  strength  of  the  modified 
milk  should  be  increased  from  month  to  month.  During  the  first 
few  weeks  it  may  be  advisable  to  use  four,  five  or  even  six  parts  of 
water  to  one  of  milk,  but  after  the  first  month  the  proportion  of 
milk  may  be  increased  in  amount  quite  rapidly.  By  the  end  of 
the  second  month,  if  the  baby  seems  to  be  thriving,  it  may  take 
equal  parts  of  milk  and  water,  and  later  on  the  milk  rnay  exceed 
the  water  until,  toward  the  end  of  the  first  year,  the  child  may  take 
almost  pure  milk.  But  this  should  be  managed  with  caution,  and  at 
the  first  sign  of  digestive  disturbance  there  should  be  a  wise  retreat. 

When  the  first  teeth  appear  it  is  time  to  add  something  more 
substantial  to  the  diet.  Many  physicians  condemn  baby  foods 
without  reservation,  but  in  this  I  cannot  concur.  Wisely  employed, 
they  are  often  of  great  value,  but  it  is  not  wise  to  use  them  unless 
absolutely  necessary,  and  then  only  in  selected  instances.  I  often, 
but  not  always,  add  them  cautiously  to  the  milk,  beginning  with 
very  little  milk,  then,  if  all  goes  well,  gradually  increase  the  pro- 
portion. Such  foods  should  not  be  used  save  in  such  conjunc- 

32 


tion  with  milk.  In  selecting  a  food  it  is  well  to  remember  that 
the  advice  of  your  doctor  is  far  more  valuable  than  that  of  your 
neighbor,  for  babies  differ. 

By  the  time  the  baby  is  a  year  old  its  diet  should  begin  to  include 
fruit  juices  and  the  whites  of  eggs.  Begin  with  a  wine-glass  of 
chicken  broth  or  bouillon,  fed  from  a  spoon,  and  as  these  things 
are  increased,  gradually  decrease  the  amount  of  bottle  food.  Soon 
after  it  turns  its  first  year  the  child  should  learn  to  drink  from  a 
small  cup.  After  that  its  meals  may  be  reduced  to  five  a  day, 
with  an  occasional  drink  of  orange  juice  and  plenty  of  water. 

The  first  meal  should  have  modified  milk  as  its  chief  con- 
stituent, with  half  as  much  infant  food  or  strained  oatmeal  added. 
The  second  meal,  in  the  middle  of  the  morning,  may  be  a  repeti- 
tion of  the  first.  Early  in  the  afternoon  a  gill  of  chicken  broth, 
or  half  as  much  beef  juice,  may  be  given,  and  this  may  be  varied 
every  few  days,  with  the  white  of  an  egg  boiled,  say,  for  a  minute. 
The  two  remaining  meals  should  have  milk  as  their  mainstay. 
After  a  month  or  so  of  such  diet,  if  the  baby  is  in  good  health,  its 
mid-morning  meal  may  begin  to  include  dry  toast,  zwieback,  thin 
oatmeal  and  other  cereals,  and  its  afternoon  dinner  may  include 
a  whole  egg,  soft-boiled  or  poached.  Fruits  should  be  given  freely, 
but  it  is  always  best  to  have  them  well  cooked. 

I  need  scarcely  refer  again  to  the  need  for  keeping  all  bottles, 
nipples,  glasses  and  spoons  absolutely  clean.  They  should  be 
scalded  after  each  meal,  and  should  be  kept,  between  meals,  in  a 
vessel  filled  with  a  dilute  solution  of  boracic  acid.  Just  before  using 
they  should  be  washed  thoroughly  in  very  hot  water.  Particular 
attention  must  be  paid  to  the  rubber  nipples.  They  are  veritable 
havens  for  wandering  germs. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  VI 

Why  is  it  that  so  many  more  bottle-fed  babies  get  sick  and  die  than 
breast-fed  babies? 

Babies  often  have  diarrhea  and  vomit  because  the  milk  is  not 
clean — has  not  been  kept  cold — has  been  kept  too  long — is  not 
properly  prepared  or  the  nursing  bottles  and  nipples  are  dirty. 

How  can  a  mother  avoid  the  danger  that  comes  to  babies  through 
cow's  milk? 

33 


She  should  consult  a  doctor  that  knows  about  babies,  and  find 
out  if  she  can  not  nurse  the  child.  If  not,  she  should  get  from  her 
doctor  a  prescription  for  preparing  the  milk  to  suit  her  baby's 
stomach.  She  should  weigh  her  baby  on  the  same  scales  once  a 
week,  and  if  she  finds  the  child  losing  weight  or  not  gaining  for 
several  weeks,  she  should  consult  her  doctor  again  and  ask  that  the 
formula  be  changed. 

What  is  the  best  and  easiest  way  to  prepare  the  milk? 

The  milk  should  be  prepared  every  morning  for  the  day's  supply. 
It  should  be  put  into  the  feeding  bottles  and  corked  with  aseptic 
cotton  and  put  on  the  ice.  Each  bottle  should  be  warmed  by  put- 
ting the  bottle  in  hot  water  just  before  giving  it  to  the  baby. 

The  bottles  should  be  boiled  just  before  filling  with  the  day's  milk. 

Throw  away  what  the  baby  leaves.  Never  give  the  left  over 
milk  to  it  for  another  feeding. 

As  soon  as  the  bottle  used  by  the  baby  is  empty,  it  should  be 
thoroughly  washed  with  cold  water — then  cleansed  with  borax  and 
hot  water  (one  teaspoonful  of  borax  to  a  pint  of  water).  The  nipple 
should  be  thoroughly  washed  after  each  nursing  with  hot  water 
and  when  not  in  use  should  soak  in  boric  water  in  a  covered  glass. 
The  nipple  must  be  rinsed  in  boiling  water  just  before  the  baby 
uses  it.  Bottles  and  nipples  should  be  boiled  once  a  day. 

Why  need  such  extreme  care  be  taken  to  sterilize  bottles  and  nip- 
ples before  giving  them  to  the  baby? 

Because  milk  is  one  of  the  best  "culture"  mediums.  Germs  de- 
velop in  milk  with  incredible  rapidity.  Therefore  you  may  often 
be  giving  poison  to  your  baby  when  you  think  you  are  giving  it 
clean,  nourishing  milk. 

What  should  a  mother  do  if  her  baby  has  diarrhea? 

She  should  stop  all  food  at  once — give  cool  boiled  water,  no 
medicine.  Take  the  baby  to  a  doctor  at  once.  It  is  dangerous 
to  wait,  especially  in  summer. 

What  causes  diarrhea? 

Diarrhea  comes  from  too  much  food — too  frequent  feeding — 
too  little  water — too  little  sleep — too  much  handling — too  little 
air,  and  from  milk  that  is  dirty  or  has  not  been  kept  on  ice. 

Why  does  a  child  vomit  and  have  diarrhea? 

Because  some  food  that  it  cannot  digest,  some  sour  or  dirty  milk 
has  been  taken  into  its  stomach,  and  it  vomits  and  has  diarrhea 
because  it  is  trying  to  get  rid  of  the  food  that  is  making  it  sick. 

34 


Why  does  diarrhea  come  to  babies  in  summer? 

Because  in  summer  milk  gets  warm,  and  germs  and  poisons  mul- 
tiply. 

Why  do  more  bottle-fed  than  breast-fed  babies  have  diarrhea? 

Because  cow's  milk  is  less  likely  to  be  pure  and  suited  to  the  baby's 
stomach  than  mother's  milk. 

How  can  a  mother  prevent  diarrhea? 

By  taking  a  baby  to  her  doctor  to  be  sure  its  food  is  right  before 
hot  weather  sets  in — by  keeping  it  out  in  the  fresh  air,  bathing  it 
daily  and  sponging  it  with  cool  water  on  hot  days — by  keeping 
it  quiet  and  letting  it  have  plenty  of  sleep.  Thus  its  body  will  be 
able  to  resist  disease. 


35 


CHAPTER    VII.— A    CHAPTER    ON    MILK 

FTER  all,  those  socialists  who  insist  that  the 
bread-and-butter  problem  is  the  one  all-in- 
clusive human  problem  are  not  very  far  from 
right.  A  man's  mental,  moral  and  physical 
make-up  depends,  to  a  degree  incredible  to 
the  casual  observer,  upon  the  food  he  eats, 
and,  to  a  degree  still  more  incredible,  upon 
the  food  he  ate  when  he  was  a  baby.  Save 
only  the  air  he  breathes,  nothing  more  potently  determines  the 
sort  of  man  he  is  to  be — not  even  his  nationality  or  his  faith. 

Of  course,  it  is  impossible  to  find  out,  with  any  approach  to  ex- 
actness, the  eventual  effect  of  a  given  food-stuff,  but  every  one  is 
well  aware  of  the  peculiar  emotional  consequences  which  arise  out 
of  certain  general  conditions  of  diet.  The  starving  man  has  no 
conscience,  and  the  dyspeptic  has  no  soul.  At  the  other  pole 
stands  the  well-fed  man  of  sound  stomach.  He  is  as  happy  after 
dinner  as  any  human  being  can  ever  hope  to  be. 

Between  these  two  extremes  one  may  find  a  thousand  other 
proofs,  physical,  and  psychical,  of  the  effect  of  food  upon  the  human 
animal.  It  is,  indeed,  fast  becoming  a  favorite  theory  among  bi- 
ologists that  many  of  those  changes  which  cause  the  evolution  of 
species  are  due  to  changes  in  nutrition;  and  there  is  even  some 
ground  for  believing  that  man's  enormous  superiority  over  all  other 
beings  to-day  is  due  in  part  to  the  fact  that  his  remote  ancestors, 
one  lucky  day,  discovered  the  art  of  cookery. 

Nature  provides  the  best  of  all  possible  foods  for  babies  in  moth- 
er's milk,  but  accidents  often  make  this  unavailable,  and  so  it 
becomes  necessary  to  seek  a  substitute.  This  substitute  has  almost 
invariably  been  the  milk  of  the  cow,  the  goat,  the  reindeer,  the 
horse  or  the  camel.  Until  recently  it  was  generally  believed  that 
the  substitute  was  as  good  as  the  thing  it  supplanted.  But  one  day 
there  appeared  a  man  named  Louis  Pasteur,  who  showed  the  world 
that  cow's  milk,  to  name  but  one  of  these  substitutes,  was  always 

36 


a  dangerous  food,  and  that,  in  a  great  many  cases,  it  was  a  violent 
and  fatal  poison. 

Pasteur  proved  this  by  his  discovery  that  cow's  milk,  by  the  time 
it  reaches  the  nursery,  always  contains  microscopic  forms  of  life. 
Some  of  these  minute  organisms,  perhaps,  are  harmless  enough, 
but  others  are  the  very  reverse.  So  noxious  are  they,  in  fact, 
that  it  is  fair  to  blame  them  for  a  large  proportion  of  the  maladies 
of  childhood,  and,  in  addition,  for  not  a  few  of  those  defects  of 
bodily  function  which,  while  not  at  once  fatal,  pave  the  way  for 
illness  and  death  later  on — perhaps  as  late  as  middle  life.  . 

The  layman  may  here  want  to  know  why  it  is  that  cow's  milk, 
if  it  is  so  badly  contaminated,  does  not  poison  the  calves  for  whom 
nature  intended  it;  and  why,  again,  if  cow's  milk  is  so  dangerous, 
mother's  milk  is  not  just  as  bad.  The  answer  lies  in  the  fact  that, 
when  any  milk  is  fed  to  the  offspring  of  its  mother  in  the  way  nature 
intended  it  to  be  fed,  it  does  not  come  in  contact  with  dirt. 

A  bacteriologist  named  Soxhlet,  in  1882,  finding  that  a  certain 
degree  of  heat  would  kill  germs  proposed  a  simple  method  of  heating 
milk,  and  it  was  believed  for  a  time  that  the  problem  was  solved. 
During  the  next  twenty  years,  however,  with  sterilization  widely 
practised,  the  death-rate  among  infants  declined  very  little. 

Then  it  was  discovered  that  heating  the  milk,  while  it  killed  the 
germs,  caused  changes  in  the  proteids,  salts,  fats  and  other  con- 
stituents, and  that  the  products  of  such  changes  were  often  danger- 
ous. It  was  also  found  that  the  constituents  of  cow's  milk  differ 
vastly  from  those  of  mother's  milk,  and  that  some  of  them  in  their 
natural  state  are  poisonous  to  human  infants.  The  result  was  an 
effort  to  change  these  constituents  in  such  a  way  that  they  would 
more  closely  resemble  the  corresponding  constituents  of  mother's 
milk.  This  effort  is  still  in  progress,  and  its  visible  fruit  is  the  large 
number  of  "modified"  milks  now  offered.  Some  of  these  are  ex- 
cellent, and,  if  properly  administered,  almost  all  of  them  do  more 
good  than  harm,  but  we  are  still  far  from  a  modified  cow's  milk  which 
exactly  duplicates  mother's  milk.  This  is  proved  by  the  fact  that, 
despite  the  progress  made,  the  death-rate  among  bottle-fed  babies 
exceeds  by  far  that  among  babies  fed  at  the  breast.  Both  have 
declined  enormously  in  the  past  twenty  years,  but  that  decline  is 
due,  not  so  much  to  improvements  in  food  as  to  improvements  in 
the  prevention  and  treatment  of  contaminated  milk  and  the  dis- 
eases it  produces. 

37 


A  gigantic  hoard  of  ancient  fallacies  and  superstitions  clusters 
about  the  nursing  mother.  There  are  a  thousand  signs,  and  por- 
tents which  command  immediate  weaning,  and  I  suspect  that, 
in  the  case  of  many  of  them,  the  wish  is  father  to  the  too-ready 
belief.  All  sorts  of  slight  indispositions  are  seized  upon  as  excuses 
for  condemning  the  baby  to  the  bottle — a  trifling  cold,  a  tempo- 
rary reduction  in  the  quantity  of  milk,  a  day  or  two  of  poor  appetite, 
a  headache,  even  a  toothache.  "That  tired  feeling,"  accompanied 
by  irregularities  in  the  milk-supply,  is  often  the  effect  of  a 
night  at  the  theatre,  a  game  of  bridge  or  an  attempt  at  heavy 
housework.  The  nursing  mother  must  take  good  care  of  herself, 
she  must  keep  early  hours,  get  plenty  of  sleep  and  food,  and  avoid 
all  emotional  excitement,  but  she  is  by  no  means  an  invalid,  and 
those  slight  aches  and  illnesses  which  afflict  all  of  us  incessantly 
do  not  afford  her  a  sound  reason  for  neglecting  her  sacred  obli- 
gation to  her  child  and  to  the  human  race.  I  have  succeeded  in 
bringing  milk  back  into  women's  breasts  who  had  not  nursed  the 
child  for  three  months. 

It  is  commonly  believed  that  if  the  nursing  mother,  for  some 
minor  indisposition,  takes  a  drug  of  any  sort,  it  will  appear  in  the 
milk  and  injure  the  child.  In  the  main,  this  is  not  true.  Very 
few  drugs  do  this,  and  it  is  easy  for  the  mother  to  avoid  those. 
Among  them  are  codein,  salicylic  acid  and  mercury.  The  last  is 
not  frequently  prescribed,  but  the  first  is  contained  in  many  pa- 
tent "headache  cures,"  and  the  second  is  often  used  to  preserve 
canned  foods.  It  is  easy  enough  to  avoid  "headache  powders" 
and  it  is  easy,  too,  to  avoid  canned  foods.  Even  in  case  the  latter 
are  eaten,  it  is  possible  to  avoid  those  which  contain  salicylic  acid, 
for  the  presence  of  this  drug,  thanks  to  the  new  pure  food  law, 
must  now  be  announced  upon  the  label. 

The  nursing  mother  would  better  eschew  all  stimulants,  but  if  she 
has  been  in  the  habit  of  drinking,  say,  a  glass  of  beer  a  day,  there 
is  no  reason  why  she  should  stop  it  during  the  nursing  period.  I 
am  no  apologist  for  alcohol,  but  it  is  an  undoubted  fact  that  those 
who  are  habituated  to  it,  in  small  quantities,  suffer  discomfort  on 
abandoning  its  use,  and  this  discomfort  may  imperil  the  milk-supply 
far  more  than  the  alcohol  itself. 

The  old  notion  that  a  bottle  of  beer,  ale  or  porter  a  day  benefits 
mother  and  child  by  "  strengthening  "  the  former  and  increasing  the 
supply  of  milk  is  an  utterly  nonsensical  superstition.  Far  from  be- 

38 


ing  strengthening,  beer  is  the  very  reverse,  and  ale  and  porter, 
having  more  alcohol  in  them,  are  even  worse.  Therefore,  it  is  dan- 
gerous for  any  woman  to  begin  their  use  during  the  nursing  period, 
but,  all  the  same,  it  is  inadvisable  for  a  woman  who  has  grown  ac- 
customed to  them  to  abandon  them  suddenly. 

The  same  thing  may  be  said  of  tea  and  coffee.  The  woman  who 
has  looked  forward  daily  to  her  afternoon  cup  of  tea  can  not  for- 
swear it  without  discomfort,  and  this  emotional  storm  may  easily 
interfere  with  the  milk-supply.  Such  a  woman  needs  her  cup  of 
tea  as  much  as  a  smoker  needs  his  after-dinner  cigar.  As  every 
one  knows,  the  smoker  who  tries  to  stop  smoking  suddenly  often 
suffers  agonies  which  bring  him  to  the  verge  of  an  actual  nervous 
breakdown. 

But  in  all  such  matters  it  is  wise  to  exercise  great  moderation. 
Beer,  tea  and  coffee  must  ever  be  regarded  not  as  necessary  foods, 
but  as  necessary  evils.  The  woman  who  employs  stimulants  to 
enable  her  to  perform  the  double  task  of  nursing  a  baby  and  doing 
heavy  housework,  is  very  short-sighted,  to  say  the  least.  Within 
a  short  time  the  penalty  will  have  to  be  paid — and  the  poor  baby, 
unluckily,  will  have  to  pay  most  of  it. 

Best  of  all  stimulants  and  auxiliaries  for  nursing  mothers  is  clean, 
fresh  cow's  milk.  An  adult  woman,  in  most  cases,  is  able  to  di- 
gest it  without  discomfort.  Its  nourishing  constituents  will  give 
her  healthy  blood  and  general  well-being,  and  these  boons  she  will 
pass  on  to  her  child.  This  is  the  best  of  all  methods  of  modifying 
cow's  milk  for  infant  consumption,  and  the  wizards  of  the  laboratory 
will  never  produce  anything  to  equal  it. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  VII 

Why  is  mother's  milk  better  for  young  babies  than  cow's  milk? 

Nature  has  put  ah1  the  elements  necessary  to  nourish  and  develop 
the  baby  in  the  milk  of  a  healthy  mother. 

Why  must  cow's  milk  be  modified  for  babies? 

It  must  be  made  as  nearly  as  possible  like  mother's  milk. 

Why  will  not  the  same  formula  do  for  all  babies? 

Each  mother's  milk  is  different,  suited  to  the  particular  needs 
of  her  baby.  No  two  babies'  stomachs  are  exactly  alike.  There- 
fore, the  doctor  makes  an  analysis  of  a  mother's  milk  to  find  out 

39 


just  how  to  prepare  the  artificial  food  for  her  baby.  Often  when 
he  finds  out  what  is  lacking  in  the  mother's  milk,  he  can,  by  special 
diet  in  the  matter,  rectify  her  rnilk  or  supplement  the  absent  in- 
gredients by  giving  the  baby  one  bottle-feeding  a  day. 

Why  must  the  baby's  formula  be  frequently  changed? 

Because  the  baby's  stomach  develops  and  requires  different  in- 
gredients to  continue  the  development.  Nature  varies  mother's 
milk  to  suit  the  baby's  developing  stomach. 

Why  is  pasteurized  milk  often  recommended  for  babies? 

Because  many  bacteriologists  believe  that  pasteurization  kills 
the  germs  in  milk  that  make  babies  sick. 

What  is  pasteurization? 

It  is  raising  milk  to  a  temperature  of  from  140  to  167  degrees 
Fahrenheit  and  keeping  it  at  that  temperature  for  from  20  to  30 
minutes. 

How  is  it  that  pasteurization  does  not  kill  the  germs  in  milk  that 
nourish  the  "favorable"  germs? 

There  is  no  reason  to  believe  that  it  does  not.  Does  this  not 
work  an  injury  to  the  baby?  Many  physicians  believe  that  it 
does.  Many  also  believe  that  this  is  a  lesser  evil  than  impure 
milk. 

Is  there  no  way  of  procuring  raw  milk,  that  is  safe? 

Yes,  milk  that  is  carefully  and  intelligently  produced  is  safe  for 
the  baby  to  take  raw  if  properly  modified. 
How  may  a  mother  know  if  raw  milk  is  safe? 

She  may  have  her  board  of  health  make  frequent  bacteriologi- 
cal tests  of  the  milk  coming  from  the  dairy.  She  may  visit  the  farm 
and  inspect  the  methods  of  producing  milk. 

What  are  some  of  the  things  up-to-date  dairymen  do  to  protect  milk? 

They  keep  the  cows  in  a  well-aired,  clean  smelling  cow-barn. 
They  feed  cows  clean,  good  food.  They  have  their  men  wear  clean 
white  milking  suits.  They  have  the  cows'  bellies  and  udders  washed 
in  disinfectant  and  the  men  wash  their  hands  in  disinfectant  before 
milking.  They  have  all  bottles  thoroughly  sterilized.  They 
have  milk  immediately  cooled  and  kept  at  50  degrees  Fahrenheit 
until  it  reaches  the  consumer. 

Does  not  this  increase  the  cost  of  producing  milk? 

Yes,  every  mother  should  be  willing  to  pay  extra  to  have  the  best 
milk.  Milk  that  is  fit  for  babies  cannot  be  produced  under  8  cents 
a  quart.  Beware  of  5  cent  milk.  Beware  of  " loose"  milk. 

40 


7s  not  10  or  15  cents  a  quart  far  milk  for  your  baby  cheaper  than 
letting  it  get  sick  and  perhaps  die? 

Yes,  you  pay  it  not  only  for  your  baby  but  for  all  babies.  Every 
time  a  mother  buys  cheap  milk  she  makes  it  harder  for  dairymen 
to  produce,  good,  clean  milk.  The  realization  of  this  fact  by  moth- 
ers will  do  more  than  any  other  thing  to  secure  a  universally 
safe  milk  supply. 

Must  milk  be  always  kept  at  50  degrees  Fahrenheit? 

Yes.  It  is  better  to  get  a  small  supply  twice  a  day  if  you  have 
no  ice.  A  small  piece  of  ice  in  water  will  keep  milk  bottles  cold  all 
day  and  sometimes  longer.  If  you  cannot  get  ice  wrap  a  cloth 
wrung  out  in  cold  water  around  the  milk  bottle.  Always  keep 
milk  covered.  If  you  know  that  the  milk  has  been  warmer  than 
50°  F.  for  long,  then  boil  it  before  using  it. 


41 


CHAPTER  VIII— THE  FOOD  FOR  GROWING  CHILDREN 

OWARD  the  end  of  the  first  year  a  human  in- 
fant begins  to  be  the  most  interesting  thing 
in  the  world.  Heretofore  it  has  lived  a  life 
of  colorless,  unconscious,  vegetative  growth; 
and  though  its  mother,  perhaps,  has  discerned 
a  meaning  and  a  portent  in  its  every  sign,  its 
actions,  in  sober  truth,  have  been  chiefly  re- 
actions,  and,  as  such,  have  sadly  lacked  motive 
and  coherence.  But  now  its  intelligence  is  dawning  and  the  mys- 
terious something  that  we  call  personality  is  unfolding.  It  begins 
to  differ  from  other  babies  of  its  age  in  a  thousand  surprising  and 
delightful  ways;  it  acquires  habits,  appetites,  little  vanities,  likes 
and  dislikes,  and  what  may  be  called  a  customary  attitude  of  mind. 
And  these  things  appear,  one  after  the  other,  with  truly  dazzling 
rapidity.  Every  week  sees  noticeable  progress.  Every  day  has 
its  perceptible  change. 

Mind  and  body  join  in  the  metamorphosis.  Muscular  and  or- 
ganic activity  increases,  and  a  multitude  of  ideas — nebulous,  maybe, 
but  still  vastly  engaging — begin  to  throng  the  child's  brain.  It 
begins  to  take  note  of  the  world  about  it;  to  recognize  differences; 
to  observe  cause  and  effect;  to  put  fact  and  fact  together.  And 
with  all  this  awakening  from  within  there  comes  a  need  of  changes 
without. 

As  every  woman  knows,  the  time  for  weaning  commonly  brings 
perils  for  the  infant.  That  this  is  the  rule  is  shown  by  the  fact  that 
popular  lore  has  given  it  the  dignity  of  an  immutable  law  of  nature. 
As  a  matter  of  fact,  there  is  no  reason  whatever  why  weaning  should 
bring  serious  consequences  to  either  mother  or  child,  for  it  is  as 
thoroughly  normal  an  incident  of  life  as  birth  or  teething.  In 
practically  all  cases  the  disasters  of  this  period  are  due  to  an  in- 
accurate reading  of  the  baby's  needs. 

Many  mothers  believe  that  a  prolongation  of  nursing  is  beneficial 
to  the  child,  but  this  is  not  true.  The  baby  fed  upon  milk  exclu- 
sively beyond  the  normal  time  is  usually  a  weak  and  anemic  child, 

42 


whose  external  appearance  gives  evidence  of  the  retarded  develop- 
ment of  its  organs  of  assimilation. 

Until  it  is  well  on  toward  its  second  birthday,  the  principal  food 
of  every  child  should  be  milk,  but  this  milk  needs  reenf  or  cement. 
Let  one  meal  be  of  modified  cow's  milk  alone,  and  the  next  of  milk 
and  toast,  with  milk  next  and  then  a  bit  of  mashed  potato,  and  so  on. 

In  this  connection,  and  before  proceeding  to  a  consideration  of 
the  diet  later  on,  it  may  be  well  to  point  out  that  the  dietary  needs 
of  every  child  are  determined  more  by  its  weight  than  by  its  age. 
An  average  baby,  weighing  about  eight  pounds  at  birth,  should 
weigh  about  seventeen  pounds  at  the  age  of  nine  months,  when  it 
is  ready  to  be  weaned.  If  it  weighs  less  than  this,  it  is  well  to  seek 
medical  advice  before  making  changes  in  its  food. 

The  same  factor  determines  the  amount  of  food  required  by  the 
child  each  day.  A  normal  baby  of  twelve  months,  weighing  twenty- 
one  pounds,  will  need  five  feedings  of  modified  cow's  milk,  of  eight 
ounces  each  and  at  intervals  of  four  hours,  in  addition  to  the  alter- 
nate meals  of  toast,  rice,  and  so  on.  But  if  the  child  weighs  but 
sixteen  or  seventeen  pounds,  six  or  seven  ounces  of  milk  will  be 
sufficient.  By  the  same  token,  if  it  weighs  more  than  twenty-one 
pounds,  it  may  well  take  a  bit  more  than  eight  ounces. 

Once  the  milk  of  early  infancy  has  been  reenf orced  by  the  starchy 
foods,  and  the  child  has  passed  the  Rubicon  in  safety,  it  is  in  order 
to  reduce  the  former,  by  slow  stages,  to  second  place.  As  soon  as 
possible  teach  the  child  to  drink  from  a  cup  and  give  it  its  daily 
milk  in  that  way.  Reduce  its  allowance  of  milk  to  four  eight- 
ounce  rations  a  day,  and  at  the  same  time  add  a  meal  of  beef-juice 
or  mutton-broth  with  a  soft-boiled  or  poached  egg.  By  the  time 
the  child  is  a  year  and  a  half  old,  broiled  and  scraped  steak  may  be 
substituted  for  the  broths. 

To  prepare  this  sear  a  round  steak,  on  the  outside  only,  over  a 
brisk  fire  and  scrape  it  into  a  fine  pulp  with  a  knife.  Take  about 
two  tablespoonfuls  of  this  and  mix  it  thoroughly  with  an  equal 
amount  of  stale  bread-crumbs.  Then  let  the  baby  eat  it  with  a 
spoon. 

Toward  the  end  of  the  second  year  it  is  time  to  abandon  the 
schedule  of  meals  I  have  given  in  a  previous  chapter,  and  to  progress, 
by  degrees,  toward  three  a  day.  Begin  by  omitting  the  meal  of 
milk  taken  just  before  bedtime  and  gradually  increase  the  im- 
portance of  the  midday  dinner.  By  this  time  the  baby  will  begin 

43 


to  show  dietetic  likes  and  dislikes,  and,  within  reason,  these  should 
be  taken  into  consideration,  for  a  child,  like  a  grown  person,  thrives 
much  better  upon  dishes  it  relishes. 

Let  breakfast  consist  of  a  cereal  with  plenty  of  milk  but  little  su- 
gar, and  a  single  egg,  either  soft-boiled  or  poached.  As  every  one 
knows,  the  American  market  affords  an  infinite  array  of  palatable 
cereals,  and  the  great  majority  of  them,  luckily  enough,  are  ex- 
cellent and  harmless.  But  it  must  be  remembered  that,  with  a  few 
exceptions,  all  of  these  so-called  breakfast-foods,  whatever  the  labels 
may  say  to  the  contrary,  are  utterly  unfit  for  children's  food  unless 
they  are  thoroughly  cooked.  It  is  best,  indeed,  to  boil  them  for 
several  hours,  and  this,  of  course,  may  be  done  most  conveniently 
the  day  before.  In  the  morning  all  that  is  necessary  is  to  warm 
them  over  and  add  hot  milk.  A  child  two  and  a  half  or  three 
years  old  should  be  given  a  single  cupful. 

It  is  essential  that  the  eggs  given  to  small  children  be  of  undoubted 
freshness,  for  those  of  the  cold-storage  variety,  besides  being  un- 
palatable, are  not  easily  digested.  One  minute's  boiling  is  all 
they  need.  Hard-boiled  eggs,  as  the  post-Easter  epidemics  of 
stomach-aches  prove,  are  not  suitable  food  for  children.  Neither 
is  it  safe  to  give  a  child  fried  eggs  or  omelets,  since  in  both  of  these 
agreeable  dishes  the  albumen  of  the  egg  is  converted  into  a  greasy, 
leathery  and  indigestible  fabric. 

Milk  should  be  the  drink  at  breakfast  for  all  children  until  their 
tenth  year.  They  should  never  drink  coffee  or  tea  under  any  cir- 
cumstances, nor  at  any  hour  of  the  day,  and  even  cocoa  is  an  ill 
substitute  for  milk.  A  single  cupful,  warmed,  is  sufficient  at 
breakfast,  since  it  is  taken,  not  to  relieve  thirst,  but  as  a  food.  Every 
child  (and  every  adult,  too,  for  that  matter)  should  take  a  drink 
of  water  upon  arising.  Breakfast  may  be  begun  within  twenty 
minutes  thereafter  without  harm. 

Until  it  is  three  years  old,  the  child's  midday  meal  should  consist 
chiefly  of  meat-broths,  chopped  or  scraped  meat  and  potatoes 
(boiled  or  baked).  Beginning  with  very  small  portions,  green 
vegetables,  such  as  spinach,  beans,  celery,  young  lettuce  well  cooked 
and  mashed,  may  be  added,  and  as  a  dessert  at  the  end  there 
may  be  part  of  a  baked  apple  or  pear  (the  skin  and  seeds  removed), 
or  a  few  stewed  prunes,  seeded.  Water,  but  no  milk,  should  be 
given  with  this  meal. 

After  its  third  birthday  the  child  may  safely  enlarge  its  animal 

44 


diet  by  the  addition  of  roasts  and  chops,  poultry  and  fish,  but  it  is 
well  to  serve  all  of  these  things  finely  chopped  until  the  fifth  or 
sixth  year,  since  all  children,  even  when  their  teeth  are  equal  to 
the  task  of  masticating  meats,  are  likely  to  bolt  them  without  prop- 
er chewing.  The  daily  allowance  should  be  not  more  than  a  few 
ounces,  and  it  should  be  reduced  on  the  first  indication  of  digestive 
disturbance. 

Needless  to  say,  all  forms  of  pork  are  dangerous,  and  no  child 
should  taste  the  flesh  of  the  swine  until  its  eighth  or  ninth  year,  at 
least.  In  particular,  such  things  as  bacon,  ham,  shoulder  and 
sausage  should  be  avoided,  and  the  same  may  be  said  of  all  parts 
of  beef,  mutton  and  poultry,  save  the  finest  cuts.  A  child's  stomach 
is  ill  fitted  for  the  digestion  of  giblet-stew,  liver  and  bacon,  sour 
beef,  calves-head,  bologna  sausage,  pigs'  feet  and  other  such  deli- 
catessen. Similarly,  it  can  ill  cope  with  fried  chops  or  fried 
fish.  The  best  meats  for  it  are  beef  and  mutton,  boiled,  broiled 
or  roasted,  and  the  best  fish  are  the  larger  ones,  which  may  be 
boiled  or  baked.  Under  poultry  I  include  chicken  (broiled  or  baked, 
but  never  fried),  roast  turkey  and  roast  barn-yard  duck. 

Many  mothers  are  under  the  impression  that  all  vegetables, 
without  exception,  have  excellent  dietetic  and  medicinal  virtues, 
but  this  is  not  true,  even  in  the  case  of  adults.  With  children  it 
is  well  to  avoid  all  save  those  which  may  be  boiled  for  several  hours, 
and  to  make  a  further  extension  of  the  ban  to  cabbage  sprouts 
and  corn.  The  vegetables  which  enter  into  a  meat  stew,  such  as 
potatoes,  carrots,  turnips  and  onions,  all  well  boiled,  are  nourish- 
ing and  harmless,  and  the  same  is  true  of  spinach.  But  it  must 
be  remembered  here  that  "well  boiled"  should  be  taken  literally. 
It  is  not  sufficient  to  boil  carrots  until  they  are  tender.  Instead, 
they  must  be  cooked  to  pieces. 

Of  all  the  fruits  which  may  enter  into  the  midday  dinner  the 
apple,  peeled,  baked  and  seeded,  is  by  far  the  best.  After  it  come 
its  near  relatives,  the  pear  and  peach.  It  is  well  to  bake  or  stew 
all  three  before  giving  them  to  children,  at  least  until  the  age  of 
six  or  seven  years,  but  the  juice  of  the  peach,  without  the  pulp,  is 
harmless.  In  the  same  way,  the  juices  of  tamarinds,  grapefruit 
and  pineapples  may  be  fed  to  children,  even  as  early  as  the  third 
year,  with  safety  and  benefit,  whereas  all  of  these  fruits,  eaten  in 
the  ordinary  way,  are  exceedingly  dangerous.  It  is  true  enough 
that  many  children  eat  them,  but  it  is  also  true  enough  that  many 

45 


children  die  of  cholera  infantum  and  diarrhea.  They  harbor  germs, 
their  woody  pulp  is  indigestible,  and  some  have  numerous  seeds. 
Cherries  and  the  smaller  berries  are  undesirable  also,  and  bananas, 
while  seedless  and  germless,  overburden  the  stomach. 

The  third  meal  of  a  child's  day,  taken  in  early  evening,  should 
be  much  like  its  breakfast,  save  in  the  absence  of  the  morning 
egg.  Milk  and  toast  or  milk  and  a  cereal  should  constitute  its 
mainstay,  with  a  cupful  of  milk  added.  At  these  two  milk-meals 
no  meat,  vegetable  or  fruit  should  be  served.  Until  its  eighth  or 
ninth  year  a  child  should  never  eat  meat  more  than  once  a  day, 
and  no  fruits  should  be  served  when  milk  is  on  the  table. 

As  soon  as  the  three-meal-a-day  schedule  has  been  established 
the  child  should  be  refused  all  solid  food  between  meals,  but  it  is 
a  good  custom  throughout  childhood — and  necessary  until  the 
seventh  year — to  give  a  generous  cupful  of  milk  in  the  middle  of 
the  morning  and  another  in  the  middle  of  the  afternoon.  If  the 
child  is  hungry,  let  it  drink  two  cupfuls,  and,  on  the  other  hand, 
do  not  press  it  to  drink  if  it  is  not  so  disposed,  as  the  appetites  of 
children  vary  as  much  as  those  of  adults. 

In  conclusion,  remember  this:  that  until  it  is  fourteen  a  child 
is  not  capable  of  dealing  with  the  miscellaneous  mass  which  makes 
up  the  civilized  bill  of  fare.  If  it  must  eat  at  the  family  table, 
see  that  its  share  of  the  dishes  is  rigorously  limited.  Discourage 
the  use  of  coffee,  chocolate  and  tea,  and  give  it  little,  if  any,  pork 
in  any  form.  Hot  rolls,  waffles,  pancakes  and  other  things  of  that 
sort,  are  always  dangerous. 

In  the  matter  of  candies  and  other  sweets  exercise  a  stern  cen- 
sorship. If  it  were  possible,  it  would  be  well  for  the  children  of 
the  land  to  grow  up  in  ignorance  of  these  delights.  Nevertheless, 
every  mother  may  do  much  to  discourage  the  ancient  custom  of 
making  candy  a  reward  for  diligence  and  good  order.  A  child  how- 
ever needs  some  sugar  and  should  have  a  little  on  its  food. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  VIII 

Why  has  a  child's  diet  more  to  do  with  its  future  welfare  than  any 
other  thing? 

The  correct  diet  of  a  baby  and  child  is  responsible  for  the  bone, 

46 


teeth,  muscle,  physical  reserve,  mental  capacity  that  is  needed  by 
a  successful  adult. 

The  following  bills  of  fare  for  young  children  were  prepared  by 
Dr.  Charles  V.  Chapin,  Commissioner  of  Health,  Providence,  R.  I., 
May,  1909. 

FROM    12    TO    15    MONTHS 

Accustom  the  child  to  drink  from  cup  and  take  food  from  a 
spoon.  Five  meals  should  be  given  in  24  hours. 

BREAKFAST 

Cup  of  cow's  milk,  a  saucer  of  oat  meal  or  barley  flour  jelly,  with 
milk,  or  cream  of  wheat  with  milk.  The  oatmeal  jelly  is  made  by 
putting  4  tablespoons  of  coarse  oatmeal  into  a  pint  of  cold  water, 
let  it  stand  24  hours  and  then  boil  it  down  to  ^  a  pint  and  strain 
through  a  coarse  cloth.  What  goes  through  is  oatmeal  jelly,  and 
may  be  kept  in  a  cool  place.  Make  a  fresh  supply  every  day. 
Milk  may  be  warmed  to  suit  taste ;  it  should  not  be  iced. 

LUNCH 
Cup  of  cow's  milk. 

DINNER 
Broth  or  beef  juice,  bread  a  day  old  crumbed  in  milk. 

SUPPER 
Bread  crumbed  in  milk. 

If  possible,  give  two  to  four  tablespoons  of  orange  juice,  or  other 
fruit  juice  in  season  before  morning  lunch.  Be  sure  the  fruit  is 
sound  and  ripe.  Do  not  give  fruit  juice  at  same  time  as  milk. 

Water  may  be  given  as  desired,  but  sparingly  at  meals. 

FROM  15  TO  18  MONTHS 

BREAKFAST 

Cup  of  cow's  milk,  saucer  of  oatmeal  jelly,  with  milk  or  flour 
or  Indian  meal  gruel,  with  milk,  small  piece  of  bread  a  day  old 
with  butter. 

47 


LUNCH 

Cup  of  milk,  small  piece  of  bread  and  butter. 

DINNER 

Broth  or  beef  juice  with  boiled  rice  or  barley,  and  a  small  piece 
of  bread  and  butter. 

AFTERNOON  LUNCH 
Cup  of  milk. 

SUPPER 

Cup  of  milk,  bread  a  day  old  and  butter,  a  little  apple  sauce  or 
pulp  of  stewed  prunes  or  baked  apples  with  skin  and  seeds  removed. 

Water  may  be  given  as  desired,  but  sparingly  at  meals. 

FROM  18  MONTHS  TO  2  YEARS 

BREAKFAST 
Cereal  and  milk.    Cup  of  milk.     Bread  a  day  old  and  butter. 

LUNCH 

Cup  of  milk  with  bread  and  butter,  or  simple  crackers,  or  Indian 
meal  Johnny  cakes  and  milk. 

DINNER 

Broth  with  boiled  rice  or  barley,  or  eggs,  soft  boiled  or  poached, 
baked  or  mashed  potatoes  with  butter  and  salt,  bread  and  butter. 

AFTERNOON  LUNCH 
Piece  of  bread  and  butter. 

SUPPER 

Milk,  bread  and  butter,  or  milk  toast,  pulp  of  baked  apple,  apple 
sauce,  stewed  prunes  or  ripe  fruit  according  to  season. 

Water  may  be  given  as  desired,  but  sparingly  at  meals. 

FROM  2  TO  3  YEARS 

Additions  to  the  diet  must  be  gradually  made  by  selecting  ar- 
ticles from  the  list  below,  always  giving  small  portions  at  first,  and 


never  trying  two  new  articles  at  one  meal.     All  food  must  be  finely 
cut  or  mashed,  and  well  chewed. 

Select  from  the  following  articles :  milk,  eggs,  soft-boiled,  poached 
or  scrambled,  baked  or  mashed  potatoes,  young  peas  or  beans, 
scraped  beef,  white  meat  of  chicken,  boiled  fish,  oatmeal,  hominy, 
wheat-germ,  cream  of  wheat  (all  these  cereals  being  thoroughly 
cooked) ;  broths  and  soups ;  white  and  graham  bread  a  day  old, 
toast,  zweiback,  plain  crackers,  milk  toast,  junket,  plain  custard, 
corn  starch  pudding,  bread  pudding,  blanc  mange,  ice  cream,  rice 
pudding;  oranges,  baked  apples,  apple  sauce,  stewed  prunes  and 
pulp  of  peaches  and  pears  if  ripe  and  sound. 

FROM  3  TO  6  YEARS 

From  3  to  6  years  select  in  addition  from  the  following  articles : 
beefsteak,  roast  lamb,  stew  of  mutton  or  beef,  hash  of  mutton, 
beef  or  fish;  mutton  or  lamb  chop,  corned  beef,  baked  beans, 
string  beans,  spinach,  asparagus,  summer  or  winter  squash,  beets, 
carrots,  turnips,  tapioca  pudding,  molasses  gingerbread,  sugar  or 
molasses  cookies,  grapes  (with  seeds  and  skin  removed),  bananas 
(if  ripe),  melons. 

During  the  3  to  6  years  four  meals  should  be  given  at  regular 
intervals,  as,  7  A.  M.,  10  A.  M.,  1.30  P.  M.  and  5  P.  M. 

The  following  is  suitable  for  a  child  of  four  years : 
BREAKFAST 

Juice  of  half  an  orange,  two  tablespoonfuls  of  cereal  with  milk 
and  sugar  or  salt,  glass  of  milk,  bread  and  butter. 

LUNCH 
Glass  of  milk  or  cup  of  broth,  bread  and  butter  or  crackers. 

DINNER 

Two  tablespoonfuls  of  stewed  meat  finely  cut,  tablespoonful  of 
baked  potato  with  butter  and  salt,  a  tablespoonful  of  green  peas 
well  mashed,  bread  and  butter,  a  cup  custard. 

SUPPER 

Milk,  bread  and  butter,  a  tablespoonful  of  stewed  prunes. 

49 


t)o  not  give  articles  on  the  following  list  till  the  child  is  four  years 
old,  many  of  them  not  until  seven  years  old. 

Fried  meats  and  vegetables,  cabbage,  raw  or  fried  onions,  raw 
celery,  cucumbers,  tomatoes,  lettuce,  radishes,  egg  plant  or  green 
corn,  hot  bread  or  hot  rolls,  buckwheat  or  other  griddle  cakes, 
fruit  cakes,  pies,  tarts,  doughnuts,  candy,  nuts,  tea,  coffee;  never 
give  children  wine,  beer  or  cider. 

When  children  are  constipated,  do  not  dose  them  with  medicines 
but  consult  a  physician.  If  children  over  two  years  of  age  are  con- 
stipated give  them  more  vegetables,  ripe  fruit,  stewed  prunes,  oat- 
meal, molasses  gingerbread,  rye  mush  and  molasses,  rye  bread  and 
Graham  bread.  Avoid  wheat  bread  and  crackers. 


50 


CHAPTER  IX.— WHAT  YOU   OUGHT  TO   KNOW   ABOUT 
YOUR  SCHOOL 

HE  German  doctors  have  invented  the  term 
"school  sickness"  to  describe  a  malady  which 
is  even  more  wide-spread,  I  fear,  in  the  New 
World,  than  in  Germany.  It  is  the  direct 
product  of  the  ancient  pedagogical  doctrine, 
that  the  more  a  child  is  forced  to  study,  the 
more  it  will  learn.  A  healthy  youngster, 
•fi  ^SS^fg?"  f,  exposed  for  a  few  years  to  the  operations  of 
this  doctrine,  is  converted  into  a  weak,  sickly  and  inefficient  being, 
with  ragged  nerves  and  a  bad  stomach.  Its  mind,  perhaps,  has 
acquired  a  mastery  of  the  scale  of  G  minor  and  of  many  irregular 
verbs,  but  its  blood  has  forgotten  how  to  grapple  with  germs. 

The  schoolmarm,  like  the  loving  mother,  is  too  assiduous  in  her 
attentions.  The  mother,  coddling  her  child,  measurably  increases 
its  chances  of  death  (as  I  have  shown  in  past  chapters) ;  and  the 
teacher,  seeking  to  lead  it  too  precipitately  into  the  Elysian  fields 
of  knowledge,  sadly  over-burdens  its  brain  and  its  eyes,  its  lungs 
and  its  muscles,  its  back  and  its  nerves.  The  result  of  this  class- 
room forcing  is  entirely  and  inevitably  pernicious.  No  good  can 
possibly  come  of  it. 

The  teacher,  I  suppose,  is  really  not  to  blame,  after  all,  for  if 
the  mother  were  not  behind  her  egging  her  on  to  her  sinister  task, 
she  would  probably  let  indolence  serve  the  benevolent  purpose 
of  mercy.  As  it  is,  she  is  expected  to  convert  the  baby  of  four  or 
five  years  into  a  virtuoso  with  an  extensive  repertoire  of  kin- 
dergarten arias ;  and  by  the  time  the  poor  child  is  seven,  she  must 
have  instilled  into  it  a  comprehensive  grasp  of  spelling,  arithmetic, 
reading,  writing,  Mexican  bead-work  and  plain  sewing.  The  mother 
of  such  a  prodigy  is  proud  of  its  attainments,  and  feels  a  glow  when 
bored  friends  hypocritically  marvel.  Later  on  she  will  wonder  why 
her  child  has  watery  eyes,  constant  colds  or  round  shoulders. 
As  a  matter  of  fact,  it  seems  to  me  to  be  very  unwise  to  send  a 

51 


boy  or  girl  to  school  until  the  age  of  eight,  at  least.  In  America, 
six  is  the  common  age  for  beginning  with  the  three  R's,  and  four 
and  a  half  the  age  for  kindergarten  mummery,  but  it  is  entirely 
improbable  that]  this  early  start  is  an  advantage,  even  if  the 
mere  accumulation  of  knowledge  be  accepted  as  the  sole  aim  of 
education.  It  is  beginning  to  be  recognized  more  that  the  child 
which  begins  school  at  eight  is  far  more  capable  of  learning 
quickly  than  the  child  which  begins  at  six;  and  at  ten  the 
former  is  almost  certain  to  know  as  much  as  the  latter,  despite 
the  fact  that  one  has  had  four  years  of  schooling,  while  the  other 
has  had  but  half  as  much.  And  after  that,  there  will  begin  to 
appear  a  noticeable  difference  between  the  two.  The  one  will 
bear  some  permanent  mark  of  its  too-early  bending  over  desk  and 
slate;  the  other  will  be  a  healthy  animal. 

The  healthy  boy  of  six  displays  little  or  no  inclination  to  dally 
with  books.  His  thirst  for  knowledge  is  satisfied  by  the  accu- 
mulation of  a  vast  store  of  baseball  lore,  with  many  intricate 
subtleties  of  rule,  precedent  and  decision;  and  his  natural  yearn- 
ing to  be  up  and  doing  finds  its  proper  outlet  in  purely  physical 
activity.  He  eats  plain,  wholesome  food,  and  he  spends  at  least 
ten  hours  of  the  twenty-four  in  sleep.  Between  meals  he  is 
in  the  open  air,  galloping,  marauding  and  fighting  his  fellows. 
He  is  a  savage,  true  enough — but  that  touch  of  savagery  will  be 
worth  more  to  him  than  Greek  in  the  years  to  come,  when  he  is 
a  grown  man  doing  the  hard  work  of  the  world,  and  needs  an 
abounding  reserve  of  brute  vigor  to  draw  upon. 

Against  this  tough  and  uncultivated  boy  place  the  typical  young 
pundit  of  his  years.  This  last  is  a  master,  not  only  of  the  spell- 
ing-book, but  also  of  the  works  of  Oliver  Optic.  He  is  studious  and 
his  parents  are  proud  of  him.  Instead  of  chasing  three-baggers 
in  the  outfield,  he  traces  the  course  of  the  river  Amazon.  He 
is  quiet,  reserved,  polite,  obedient — and  has  a  touch  of  mild 
vanity.  He  has  no  liking  for  the  barbarous  sports  of  other  boys. 
He  excels  at  none  of  their  games.  At  a  baseball  match  he  is  con- 
tent to  keep  score. 

Such  a  boy  I  believe,  is  as  abnormal  as"  a  boy  with  an  obvious 
physical  deformity.  Instead  of  being  encouraged  in  his  unhealthy 
studiousness,  as  is  commonly  the  case,  he  should  be  taken  from 
school  and,  to  borrow  a  lowly  term,  "turned  out  to  grass."  That 
is  to  say,  he  should  be  led,  willy-nilly,  into  the  savage  mode  of 

52 


life  of  the  normal  boy,  in  the  hope  that  it  will  awaken  in  him  some 
spark  of  the  savage.  His  dislike  for  games  is  really  nothing  but 
a  feeling  of  physical  incapacity.  He  realizes  that  he  is  not  as 
strong  and  tough  as  other  boys,  and  so  he  shrinks  from  competing 
with  them.  Let  him  put  his  books  aside  for  a  while — let  him 
straighten  up  his  bent  back,  breathe  pure  air,  get  wet  by  the  rain, 
and  make  acquaintance  with  splinters,  bruises  and  sunburn — and  his 
shrinking  will  begin  to  disappear.  Some  day,  let  us  hope,  he  will 
have  progressed  so  far  that  he  will  return  home  with  a  black  eye, 
acquired  honorably  in  open  and  valiant  combat.  When  that 
day  arrives,  it  will  be  time  to  send  him  back  to  school. 

Three  hours  a  day  is  enough  study  for  any  child  during  its  first 
year  or  two  in  school,  and  this  period  should  be  broken  by  a  recess 
of  at  least  half  an  hour.  In  many  large  American  cities  the  day's 
session  is  divided  into  two  parts — one  of  two  and  a  half  or  three 
hours  and  the  other  of  two  hours  or  less,  with  an  intermission  of  an 
hour  or  an  hour  and  a  half.  This  is  rather  too  much  for  the  child 
of  seven  or  eight,  especially  since  home  study  is  commonly  added, 
but  there  is  one  saving  grace  to  the  scheme,  and  that  lies  in  the  long 
midday  recess. 

It  is  very  important  that  the  meal  eaten  during  this  recess  be 
a  warm  one,  and  whenever  possible  it  should  be  prepared  and  eaten 
at  home.  Until  a  child  is  ten  or  twelve  years  old  it  must  have  its 
dinner,  or  principal  meal  of  the  day,  at  noon.  The  rest  of  the 
household  may  dine  in  the  evening,  but  for  the  youngster  so 
heavy  a  repast  near  bedtime  is  certain  to  be  deleterious.  A  bundle 
of  cold  sandwiches  will  not  serve  as  a  substitute  for  the  midday 
dinnner,  for  the  child  needs  not  only  the  warm,  home-cooked  food, 
but  also  the  walk  home,  the  change  of  scene,  the  bit  of  play  on  the 
way,  and  the  hour's  forgetfulness  of  lessons. 

Sitting  still  for  two  or  three  hours  is  an  exhausting  and  pain- 
ful proceeding  to  a  child  of  seven  or  eight.  It  is  as  painful,  almost, 
as  it  would  be  for  a  grown  man  to  stand  immovable  for  the  same 
length  of  time.  The  child,  unable  to  bear  the  strain,  is  apt  to 
lounge  in  some  unhealthful  manner.  Out  of  this  lounging — this 
resting  upon  the  desk — come  round  shoulders.  And  out  of  round 
shoulders  come  a  host  of  ills. 

The  strain  upon  the  back,  in  school,  is  equaled  by  the  tax 
upon  the  eyes.  If  blackboards  were  really  black,  they  might  just- 
ify their  existence,  but  in  practise  they  are  usually  a  dirty  gray, 

53 


which  reflects  the  light  in  blinding  flashes  and  subjects  the  eyes  to 
harassing  duty.  From  them  the  child  turns  to  its  book — and  there 
it  encounters  more  assaults  upon  its  vision.  The  fruits  of  this 
eye-strain  are  so  many  that  it  would  be  impossible  to  catalogue 
them.  They  range  from  irritability  and  headache  to  serious  de- 
rangements of  the  digestion. 

How  many  mothers  who  read  this  have  ever  entered  the  school- 
rooms in  which  their  children  spend  from  four  to  six  hours  a  day? 
It  is  not  common,  I  believe,  for  such  visits  of  inspection  to  be 
made,  and  in  many  places  they  are  no  doubt  discouraged  by  the  ped- 
agogic authorities,  but  they  are  plainly  a  part  of  every  mother's 
duty.  You  may  find  that  your  child  is  forced  to  sit  all  day  beside 
a  draf ty  window  or  near  a  heater ;  that  it  is  so  far  from  the  black- 
board that  it  can  scarcely  see ;  that  it  occupies  a  desk  too  large  or 
too  small  for  it;  or  that  its  schoolroom  is  a  dark,  evil-smelling, 
ill- ventilated  place. 

Suppose  one  or  another  of  these  conditions  is  found?  What 
can  you  do  to  remedy  it?  Well,  you  can  protest,  certainly,  and  if 
your  single  protest  does  no  good  you  can  get  other  mothers  to 
protest  with  you.  If  the  school  is  a  private  one,  and  you  are  pay- 
ing tuition,  your  objections  will  be  heard  politely  enough;  and  even 
if  it  is  a  public  school,  and  the  principal  is  entrenched  behind  the 
patronage  of  the  ward  boss,  you  will  not  find  him  so  independent 
as  you  may  think.  The  disgusting  condition  of  the  public  schools 
in  many  American  cities  is  due  almost  entirely  to  the  lethargy  of 
parents.  Whenever  and  wherever  there  has  been  intelligent  and 
active  criticism  of  school  methods  and  housing,  substantial  re- 
forms have  followed.  Even  a  ward  boss  has  a  healthy  respect 
for  the  collective  indignation  of  a  party  of  mothers. 

If,  after  exerting  your  best  efforts  to  work  improvements,  you 
find  that  alarming  conditions  still  exist,  take  your  child  away  from 
school,  by  all  means — especially  if  it  is  still  under  nine  years  old. 
It  is  during  the  first  few  years  that  the  greatest  damage  is  done, 
and  the  least  advantage  gained  by  risking  it.  I  am  firmly  con- 
vinced, indeed,  that  the  average  school  does  more  harm  than  good 
to  all  children  under  nine.  Too  many  are  herded  into  one  class, 
and  too  little  attention  is  paid  to  individual  idiosyncrasies.  The 
theory  is  that  all  children  of  an  age  are  alike — a  theory  comparable, 
for  soundness,  to  the  political  doctrine  that  all  men  are  equally 
capable  of  voting  intelligently.  The  bright  child  is  retarded  by 

54 


the  stupid  ones,  and  the  healthy  child  is  contaminated  by  the  un- 
healthy child.  The  level  that  is  thus  attained  is  a  very  low 
level,  indeed. 

No  doubt  there  has  occurred  to  many  readers  a  practical  objection 
to  one  part  of  my  argument.  It  is  this:  that  if  a  child  be  kept 
from  school  until  it  is  eight  years  old  it  will  go  through  its  whole 
period  of  schooling  two  years  behind  the  child  which  began  at  six. 
The  children  in  a  school  are  not  taught  individually,  but  in  classes, 
and  after  it  is  once  entered  in  a  class,  a  child's  rate  of  progress  is 
the  class  rate  of  progress. 

In  answer  to  this,  let  me  suggest  that  the  child  be  kept  from 
school,  not  only  until  it  is  eight,  but  until  it  is  ten.  Let  it  spend 
its  whole  time  at  play  until  it  is  eight,  and  then  let  it  begin  to 
study  at  home,  either  under  its  mother's  supervision  or  in  care 
of  some  competent  teacher.  If  it  begins  with  two  hours  a  day, 
and  proceeds  to  three  and  finally  four,  it  will  be  fully  as  far 
advanced,  after  two  years,  as  the  child  which  has  spent  four 
years  picking  up  a  haphazard  knowledge  of  the  rudiments  in  the 
average  schoolroom.  It  will  then  be  possible  to  enter,  not  in 
the  first  class,  but  in  the  fifth,  and  it  will  go  through  the  succeeding 
classes  with  children  of  its  age. 

The  labor  of  teaching  a  child  the  things  taught  in  the  first  few 
grades  of  a  primary  school  is  not  nearly  so  forbidding  as  you  may 
imagine.  In  the  classroom  the  individual  child  gets  no  more  than 
a  few  minutes  of  the  teacher's  undivided  attention  a  day,  and  yet 
it  makes  progress.  If  you  fancy  that  it  derives  much  benefit  from 
the  instruction  given  to  the  other  children,  you  have  but  to  visit 
a  classroom  to  be  undeceived.  On  the  contrary,  most  of  its  time, 
when  it  is  not  actually  performing  its  own  day's  task,  is  spent  in 
necessary,  if  unlawful,  efforts  to  relieve  the  intolerable  tedium  of 
its  imprisonment. 

I  am  convinced,  indeed,  that  an  ordinarily  intelligent  child, 
with  an  hour's  individual  instruction  a  day,  five  days  a  week,  can 
make  far  greater  progress  than  the  average  child  in  the  average 
classroom.  And  just  consider  what  it  gains!  Instead  of  being 
shut  up  for  hours  in  a  noisy  room,  it  has  one  hour  of  work  and 
all  the  rest  of  its  time  for  play — for  fresh-air  and  healthful  mus- 
cular activity.  If  it  arises  moody  or  dull,  its  hour  of  study  may 
be  removed  from  morning  to  afternoon,  or  divided  into  two  half 
hours.  It  may  devote  the  whole  of  the  rare,  bright  days  of  Win- 

55 


ter  to  play,  and  make  up  for  its  lost  time  on  stormy  days.  It 
will  have  a  clean,  airy  room  for  study,  with  no  distractions;  warm 
meals ;  and  no  home-study  tasks  for  the  evenings. 

Later  on,  of  course,  the  school  will  begin  to  reckon — if  only  for 
the  salutary  effect  that  its  rough  democracy  and  emulation  have 
upon  character.  But  for  the  very  young  child  the  classroom  holds 
out  few  advantages.  It  is  the  easiest  way,  perhaps,  but  it  is  always 
the  way  of  headache,  anemia,  lassitude,  nervousness,  hysteria 
and  broken  health. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  IX 

Why  do  you  send  your  child  to  school? 

To  fit  him  for  life — to  make  him  a  self-supporting,  self-respect- 
ing, happy  citizen.  What  is  the  first  essential  to  this — good  health 
— with  it  nine-tenths  of  the  battle  of  life  are  won. 

What  are  the  years  when  health  is  established? 

From  birth  to  16  years  of  age. 

How  many  of  these  years  are  spent  in  school? 

Ten  or  eleven. 

Could  an  unhealthful  school  environment  unfit  a  child  for  life? 

Yes,  it  often  does. 

How? 

Bad  air  breeds  contagion.  Bad  air  and  contagious  diseases 
undermine  a  child's  vitality — poor  light,  dirty  windows,  shiny 
blackboards,  fine  print,  glossy  paper,  too  much  close-range  work 
strain  a  child's  eyes.  Eye-strain  causes  indigestion,  nervousness, 
injured  eyesight.  Ill-adjusted  desks  cause  round  shoulders,  curved 
spines,  restlessness.  Too  little  recess, — relaxation  from  application 
to  lessons — overstrains  the  child's  nerves  and  disgusts  him  with 
school  work  or  any  work. 

Dust,  dry-sweeping,  unclean  rooms  spread  tuberculosis — sun, 
fresh  air,  soap  and  disinfectant  kill  tuberculosis  germs. 

Cold  lunch  eaten  at  school  gives  a  child  indigestion — malnutrition. 
Every  child  should  have  a  hot,  hearty,  nourishing  dinner,  at  noon, 
at  home  if  possible. 

Should  not  the  place  where  your  child  spends  the  greater  part  of 
his  days  for  at  least  9  months  in  the  year,  receive  every  mother's  in- 
dividual attention? 

56 


By  all  means.  Neglect  of  the  school  environment  might  mean 
life-long  failure  to  the  child  and  disappointment  to  the  mother 
and  father. 

What  should  a  mother  look  for  in  her  child's  school? 

Open  windows,  a  schoolroom  thermometer,  adjustable  desks 
adjusted, — clean  floors — scrubbed — not  dry  swept, — good  light  for 
every  child  in  the  room — recess  out-of-doors — individual  drinking 
cups,  individual  towels. 

Cleanly  dressed  children. 

A  medical  inspector  to  examine  the  children  for  contagious  dis- 
eases— such  as  consumption,  measles,  scarlet  fever,  pneumonia, 
diphtheria,  mumps,  colds,  sore  throats,  tonsilitis,  scabies,  pediculo- 
sis. A  physician  to  examine  children  for  physical  defects  such  as 
bad  teeth,  adenoids,  enlarged  tonsils,  defects  of  hearing  and  sight, 
tuberculosis. 

Are  these  things  absolutely  essential  to  the  good  health  of  school 
children? 

Yes. 

What  should  a  mother  do  if  she  finds  these  essentials  lacking? 

She  should  go  to  the  principal  of  the  school  and  ask  to  have  de- 
fects of  school  equipment  rectified.  If  the  principal  cannot  do 
this  she  should  go  to  the  school  board  and  make  complaint.  If 
the  school  board  will  or  can  do  nothing,  she  should  put  the  matter 
before  the  citizens  of  her  town,  either  through  the  local  paper, 
Mothers'  Club  or  Citizens'  Union.  No  government  can  long  resist 
the  demands  of  a  number  of  parents  for  the  welfare  of  their  children. 

What  should  a  mother  do  if  the  school  doctor  finds  physical  defects 
in  her  child? 

She  should  at  once  send  the  child  to  a  physician,  dentist,  or 
surgeon  and  have  the  defect  rectified.  If  taken  in  time  the  child 
can  usually  be  made  normal.  If  neglected  its  health  will  be  un- 
dermined. 

Should  children  with  tuberculosis  be  allowed  to  be  in  school  with 
other  children? 

Never. 

In  some  cities  there  are  special  schools  for  tuberculous  children. 
It  is  not  safe  to  risk  infection  of  well  children.  It  is  very  unfair 
to  the  tuberculous  child.  It  needs  fresh  air  all  the  time,  very  little 
mental  effort,  plenty  of  rest  and  sleep,  large  quantities  of  milk 
and  eggs  and  the  constant  attention  of  a  physician. 

57 


How  can  the  tuberculous  children  be  weeded  out? 

Every  child  should  be  examined  for  tuberculosis  before  entering 
school  each  fall.  Children  with  tuberculous  parents  should  have 
special  tests.  Their  sputum  should  be  examined  bacteriologically 
and  a  tuberculin  skin  test  made.  Children  who  have  not  tuber- 
culosis, but  have  tuberculous  parents,  or  are  especially  weak, 
should  be  in  school  but  part  of  the  day;  the  rest  of  the  day 
they  should  be  out-of-doors  or  resting.  They  should  have  a 
feeding  of  milk  and  eggs  between  meals,  morning  and  afternoon. 


58 


CHAPTER  X.— NEED  EVERY  CHILD  HAVE  "CATCHING 
DISEASES?" 

HE  notion  that  every  child  is  doomed  to  suffer 
from  catching  diseases  at  some  time  during 
its  first  ten  years,  is  a  dangerous  and  stupid 
error.  There  is  no  more  reason  why  a  child 
need  have  diphtheria,  scarlet  fever,  measles, 
or  whooping  cough  than  why  it  need  have 
smallpox,  lockjaw  or  hydrophobia  if  proper 
preventive  methods  be  used.  All  these  in- 
fections are  preventable. 

What  is  the  best  method  far  the  prevention  of  contagious  diseases? 
Thorough  physical  examination  of  the  child  at  frequent  inter- 
vals;   a  healthy  condition  of  mouth  and  teeth;  removal  of  enlarged 
tonsils  or  adenoid  growths;  care  and  isolation  of  a  child  with  a 
cold  or  sore  throat ;  living  and  sleeping  in  the  fresh  air. 

Why  do  bad  teeth,  failure  to  brush  teeth  daily,  neglected  tonsils  and 
adenoids  favor  contagious  diseases? 

Because  germs  lodge  in  decayed  teeth  and  in  the  unhealthy  tissue 
of  tonsils  and  adenoids. 

Why  does  neglect  of  colds  increase  contagious  diseases? 
Because  a  cold  is  often  the  first  sign  of  such  diseases  as  whoop- 
ing cough,  measles,  scarlet  fever,  etc.,  at  the  time  when  these  dis- 
eases are  most  infectious.     Because  a  neglected  cold  may  often 
result  in  pneumonia  or  tuberculosis. 

What  are  the  first  steps  to  take  when  a  child  conies  down  with  a  con- 
tagious disease? 

Send  for  a  doctor.    Put  the  child  to  bed  in  a  well-aired,  sunny 
room.    Keep  it  away  from  other  members  of  the  family.    Keep 
persons  who  have  been  exposed  to  the  disease  away  from  other 
people  or  school.    Report  the  disease  to  the  board  of  Health ;  put  a 
notice  on  the  door  stating  that  the  disease  is  present  in  the  house. 
What  is  the  invariable  treatment  for  contagious  diseases? 
1.    Fresh  air. 

59 


2.  Complete  quarantine. 

3.  Disinfection  of  all  sheets,  dishes,  clothing  used  for  the  patient. 

4.  Fumigation  of  the  room. 

5.  Thorough  examination  of  the  child  by  a  physician  on  recovery 
to  prevent  further  complications. 

6.  Nourishing  food,  such  as  fresh  eggs  and  milk,  outdoor  life 
and  rest. 

What  should  your  medicine  chest  contain? 

Absorbent  cotton,  aseptic  gauze,  carbolic  vaseline,  castor  oil, 
hot  water  bag,  and  NO  PATENT  MEDICINES. 


60 


CHAPTER  XL— IF  YOUR  BABY  HAD  DIPHTHERIA 

F  all  the  maladies  that  afflict  small  children  none 
causes  more  terror  to  the  agonized  mother 
than  diphtheria.  It  has  an  air  of  mystery  and 
awfulness.  It  seems,  almost,  to  presage  cer- 
tain death.  The  doctor's  reluctant  verdict — 
his  brief,  but  positive  orders  regarding  isolation 
and  nursing — the  mention  of  antitoxin,  of 
antiseptics,  of  subcutaneous  injections — the  post- 
ing of  the  warning  sign  upon  the  door — all  of  these  things  bring 
the  mother  of  the  little  patient  to  a  pitiable  state  of  alarm. 

And  yet,  for  all  its  indubitable  dangers,  diphtheria  is  one  of  the 
diseases  that  modern  medicine  may  fairly  claim  to  have  conquered. 
Its  cause  is  known  and  its  course  is  known.  It  may  be  prevented, 
and  in  the  great  majority  of  cases  it  may  be  cured.  When  the 
doctor  pronounces  its  dread  name,  there  is  no  reason  whatever 
why  one  should  give  thought  to  grievous  possibilities,  because 
these  possibilities,  fortunately  for  the  human  race,  are  now  hap- 
pily remote.  Ten  years  ago  more  than  half  of  the  babies  who  took 
diphtheria  died  from  it.  To-day  the  deathrate  is  less  than  one- 
tenth,  and,  under  conditions  easily  attainable,  than  less  one- 
twentieth. 

The  credit  for  this  belongs  absolutely  to  the  men  who  devised 
and  perfected  diphtheria  antitoxin.  No  other  single  medical  dis- 
covery of  recent  years  has  better  proved  its  value  to  the  human 
race,  or  better  justified  the  bold  experimentation — the  ruthless 
slaughter  of  rabbits  and  guinea  pigs — the  patient  toil  with  culture 
tube  and  microscope — of  medical  science. 

No  doubt  you  have  heard  assertive  persons  say  that  antitoxin  is 
a  snare,  and  that  it  kills  more  babies  than  it  cures,  and  perhaps 
this  sort  of  criticism  has  made  some  impression  upon  you.  If  it 
has,  be  warned  in  time.  Your  own  child  may  take  diphtheria  to- 
morrow. If  it  does,  antitoxin  is  the  only  thing  under  the  sun  that 
will  aid  it.  When  your  doctor  tells  you  so,  show  your  faith  in  him 


by  letting  him  go  ahead  with  his  work  of  inoculation.     Half  an 
hour's  delay  means  regret  poignant  and  everlasting. 

To  understand  the  nature  of  diphtheria  antitoxin  it  is  necessary 
first  of  all,  to  know  something  about  diphtheria.  In  the  view  of 
the  layman  it  appears  as  an  extraordinarily  violent  species  of  sore 
throat,  with  an  unaccountable  tendency  to  infect  others  and  to 
end  in  death.  In  the  view  of  the  pathologist  it  is  an  acute  infectious 
disease  of  the  first  class,  caused  by  a  definite  organism  called  the 
bacillus  diphtheria,  which  secretes  a  powerful  soluble  toxin,  or 
poison;  which,  in  turn,  produces  death  by  inhibiting  the  proper 
action  of  the  heart. 

The  bacillus  diphtheria,  despite  the  popular  notion  of  bacilli, 
is  not  an  animal,  but  a  plant.  Unlike  the  varieties  of  vegetation 
that  are  most  familiar  to  us,  it  does  not  need  an  immovable  soil 
for  its  roots,  but  floats  about  and  grows  luxuriantly  in  the  human 
blood,  or  in  any  other  suitable  liquid.  It  is  so  small  that  a  mi- 
croscope magnifying  one  thousand  times  barely  reveals  it.  In 
shape  it  resembles  a  minute  rod,  rather  thick  in  section,  and  with 
one  end  swelling  out  a  bit.  It  tends  to  grow  in  curious  little  clus- 
ters which  much  resemble  the  five  outstretched  fingers  of  a  human 
hand. 

The  bacillus  diphtheria  is  very  tenacious  of  life,  and  even  when 
dried  and  seemingly  withered,  it  is  capable  of  remaining  alive  for 
months.  This  explains  the  fact  that  it  is  very  difficult  to  stamp 
out  an  epidemic  of  diphtheria.  Once  the  bacilli  gain  a  foothold 
in  a  house,  a  school  or  a  neighborhood,  they  are  very  apt  to  infect 
child  after  child.  They  float  about  in  the  air;  they  appear,  in 
countless  millions,  in  the  mouths  of  children  who  are  ill  with  the 
disease ;  and  they  appear,  too,  though  in  less  number,  in  the  mouths 
of  those  who  may  be  perfectly  well.  Only  the  most  skilful  use  of 
antiseptics,  by  some  one  with  sound  scientific  knowledge,  is  of  any 
value  in  the  effort  to  stamp  them  out. 

When  a  swarm  of  these  bacilli  take  lodgment  in  a  child's  throat 
or  tonsils,  they  begin  at  once  to  increase  and  multiply.  Within 
a  few  hours  they  are  present  by  the  billion.  Each  individual  throws 
off  a  minute  stream  of  poison,  and  these  streams,  commingling, 
attack  the  throat  tissue.  They  kill  the  mucous  membrane,  and 
the  little  blood-vessels  below  it  rush  scar-forming  materials  to  the 
scene  to  repair  the  damage.  At  the  same  time  the  white  blood 
corpuscles  in  the  blood  vessels  engage  the  bacilli  in  combat — 

62 


attacking  them  and  trying  to  swallow  them.  Before  long  the  scene 
of  the  battle  is  littered  with  all  sorts  of  de*bris — dead  membrane, 
dead  bacilli,  dead  corpuscles,  and  bits  of  scar  tissue.  This  debris, 
in  the  end,  forms  quite  a  large  mass,  and  becomes,  in  fact,  the 
familiar  diphtheria  throat  membrane. 

The  membrane  obstructs  the  windpipe  of  the  sufferer,  and  unless 
something  is  done  to  break  it  strangulation  is  apt  to  follow.  Some- 
times it  is  necessary  to  cut  into  the  neck  of  the  patient  below  the 
place  of  obstruction  and  insert  a  silver  tube,  to  give  the  lungs  air. 
More  often,  it  is  possible  to  force  a  tube  down  the  throat,  in 
front  of  the  membrane.  This  operation  requires  great  skill,  and 
should  be  entrusted  only  to  some  expert  who  has  done  it  often 
before. 

Despite  the  size  and  toughness  of  the  membrane,  however, 
strangulation  is  seldom  the  cause  of  death  in  diphtheria.  Much 
more  often,  the  patient  dies  of  heart  failure,  produced  by  the 
activity  of  the  poisons  secreted  by  the  bacilli.  These  poisons  are 
frightfully  virulent,  and  being  soluble  they  are  carried  to  all  parts 
of  the  body  in  the  blood  stream.  It  is  evident,  therefore,  that  if 
they  can  be  attacked  and  destroyed  in  the  blood  their  power  of 
doing  damage  may  be  broken.  This  office  of  attacking  and  des- 
troying them  is  the  function  of  diphtheria  antitoxin. 

The  manufacture  of  the  antitoxin  is  based  upon  the  fact  that 
healthy  blood,  whenever  germ  poisons  appear  in  it,  begins  auto- 
matically and  at  once  to  make  antidotes  for  them.  Inject  a  few 
drops  of  diphtheria  poison  into  the  veins  of  a  healthy,  full-grown 
man,  and  his  blood  will  at  once  neutralize  it,  and  as  a  result  he  will 
show  no  bad  effects  whatever.  If  the  amount  injected  be  very 
small,  his  blood,  indeed,  will  manufacture  a  great  deal  more  anti- 
dote than  is  necessary  to  neutralize  it,  and  will  keep  on  making 
antidote  for  some  time  after  all  of  the  poison  present  has  been 
rendered  harmless. 

But  if  a  large  quantity  of  poison  be  injected,  or  if  active  bacilli 
in  large  numbers  are  lodged  somewhere  in  the  body,  and  are  hard 
at  work  sending  forth  more  poison,  the  blood  will  soon  give  up  the 
hopeless  struggle.  It  will  fight  valiantly  as  long  as  possible,  and  in 
the  course  of  the  battle  it  will  neutralize  a  vast  quantity  of  poison, 
but  in  the  end  the  enemy  will  be  too  strong  for  it,  and  it  will  sur- 
render. This  is  what  happens  when  a  child  is  infected  with  diph- 
theria and  a  colony  of  bacilli  lodge  in  its  throat.  For  a  while  its 

63 


blood  fights  on,  but  in  the  end  it  is  overcome,  and  the  poison  begins 
to  course,  without  obstruction,  through  its  veins. 

Fortunately,  it  is  possible  to  lend  the  body  aid  by  reinforcing 
it.  And  how?  Simply  by  injecting  into  the  patient's  veins  blood 
from  some  animal  which  is  capable  of  making  a  better  fight  against 
diphtheria  than  a  human  being.  In  practise  the  animal  selected 
is  always  the  horse.  It  is  a  hardy,  cleanly  and  healthy  beast; 
it  is  capable  of  losing  a  great  deal  of  blood  without  damage;  and 
its  blood  has  a  peculiar  capacity  for  opposing  and  neutralizing  the 
poisons  of  the  diphtheria  bacillus. 

A  fine,  strong  horse  is  selected,  and  the  manufacture  of  antitoxin 
is  begun  by  injecting  into  one  of  its  veins  a  small  amount  of  diph- 
theria poison.  The  amount  is  so  small  that  the  blood  of  the  horse 
neutralizes  it  at  once,  and  the  animal  suffers  no  ill  effects  at  all. 
Four  days  later  twice  as  much  poison  is  injected.  This,  too,  is 
neutralized  by  the  horse's  blood,  and  in  addition,  the  blood,  stim- 
ulated to  activity,  manufactures  a  large  extra  portion  of  antidote. 
Four  days  later  a  still  larger  dose  of  poison  is  administered,  and 
thereafter  for  six  months  the  process  is  kept  up.  The  horse's 
blood,  in  the  long  battle,  always  manages  to  keep  a  bit  ahead  of 
the  poison.  At  the  end  of  the  six  months,  it  is  so  heavy  with  an- 
tidote that  it  is  capable  of  neutralizing  any  conceivable  amount 
of  poison.  The  horse,  in  fact,  is  utterly  diphtheria-proof.  One 
might  inject  into  its  veins  enough  diphtheria  poison  to  kill  an 
army,  and  it  would  go  unscathed. 

All  that  remains  is  to  draw  off  some  of  this  immunized  blood 
and  get  it  into  the  veins  of  the  human  patient.  The  process,  it 
is  obvious,  is  a  very  simple  one.  One  of  the  veins  of  the  animal  is 
opened,  a  quantity  of  its  blood  is  collected,  and  a  portion  of  this 
blood  (after  it  has  settled  and  has  been  strained)  is  injected  into 
the  human  patient.  The  strained  blood  is  a  sticky,  yellowish  liquid. 
It  is  what  the  doctors  and  druggists  call  diphtheria  antitoxin. 

This  antitoxin,  then,  is  nothing  more  than  horse  blood  which 
has  acquired  an  extraordinary  capacity  for  combating  diphtheria 
poisons.  When  it  enters  the  blood-vessels  of  the  patient  it  begins 
at  once  to  seek  out  the  diphtheria  poisons  and  destroy  them.  It 
does  its  work  almost  instantaneously,  and  if  enough  is  used,  the 
result  is  certain.  All  of  the  diphtheria  poisons  are  neutralized — 
and  the  patient  begins  to  grow  better. 

But  it  is  plain  that  the  antitoxin  must  be  used  quickly  and  in 

64 


sufficient  quantity  if  this  desirable  end  is  to  be  achieved.  So  long 
as  the  patient's  blood  fights  on  unaided,  the  amount  of  poisons 
present  in  it  will  go  on  increasing.  By  and  by  these  poisons  may 
be  present  in  such  great  quantity  that  they  will  begin  to  impede 
the  action  of  the  heart.  When  that  stage  is  reached  the  patient  is 
dying,  and  it  is  too  late  to  battle  with  the  disease. 

Therefore,  it  is  important  that  the  diphtheria  antitoxin  be  used 
just  as  soon  as  there  is  good  ground  for  believing  that  diphtheria 
is  present.  If  it  is  used  on  the  first  day  of  the  disease,  the  latest 
statistics  show  that  it  will  save  the  lives  of  ninety-eight  patients 
out  of  one  hundred.  If  its  use  is  put  off  until  the  second  day,  it 
will  save  only  ninety-six.  If  it  is  used  after  the  fourth  day,  it  will 
not  save  more  than  eighty  out  of  a  hundred. 

And  it  must  be  used  in  sufficient  quantity.  If  one  injection  does 
not  bring  relief,  let  there  be  another,  and  then  another,  and  yet 
another.  The  antitoxin  can  do  no  harm.  In  cases  on  record, 
wherein  its  use  has  long  been  delayed,  almost  incredible  quantities 
have  been  injected.  The  scientific  physician  has  a  safe  rule.  He 
knows  that  there  is  hope  so  long  as  life  lasts;  and  so  he  proceeds 
with  the  treatment  until  the  danger  line  is  passed  and  the  patient 
shows  signs  of  it. 

You  mothers  learn  a  great  deal  about  the  care  of  children,  but 
in  the  presence  of  a  disease  as  dangerous  as  diphtheria  you  must 
yield  up  the  custody  of  your  child  to  the  doctor  and  the  nurse. 
Your  family  doctor  must  be  a  man  in  whom  you  have  implicit 
confidence.  Select  him  with  the  utmost  care,  and  do  it,  by  pref- 
erence, at  some  time  when  there  is  no  sickness  in  the  household. 
Then,  after  you  have  chosen  him  and  sickness  comes,  give  him  the 
faith  and  support  that  his  learning  and  experience  deserve.  His 
whole  life  is  devoted  to  the  cure  of  human  ills,  and  your  common 
sense  will  teach  you  that,  if  he  is  an  intelligent  man,  this  devotion 
must  profit  him  in  wide  knowledge. 

Do  not  oppose  him  or  hamper  him  in  the  sick-room .  He  knows 
what  is  best  for  the  patient.  If  he  proposes  to  use  antitoxin,  let 
him  do  so  at  once.  The  persons  who  go  about  denouncing  such 
invaluable  gifts  to  the  human  race  are  the  heirs  of  those  ancient 
wiseacres  who  laughed  at  Sir  William  Harvey  when  he  said  that 
the  blood  flowed  through  the  veins,  and  hooted  at  Jenner  when  he 
proposed  to  vaccinate  all  England,  and  called  Klemke  a  lunatic 
when  he  maintained  that  tuberculosis  was  infectious. 

65 


That  antitoxin,  employed  in  time,  will  cure  diphtheria  is  a  fact 
as  easily  demonstrable  as  the  fact  that  the  sun  rises  every 
morning.  And  the  fact  that  nothing  else  in  the  world — no  medicine, 
throat  mopping  or  surgical  operation — will  cure  it,  is  demon- 
strable, too.  Medicines  and  moppings  have  their  usefulness  as 
aids,  but  it  is  the  antitoxin — or,  when  the  antitoxin  is  not  used, 
long-suffering  nature — that  wins  the  battle. 

It  is  evident,  however,  that  the  antitoxin,  while  it  neutralizes 
the  poisons  secreted  by  the  bacilli,  does  not  directly  kill  the  bacilli 
themselves.  The  business  of  getting  rid  of  them  falls  upon  the 
white  blood  corpuscles,  and  the  great  majority  of  them  are  soon 
gobbled  up,  but  not  a  few  remain.  These,  unless  something  is 
done  to  kill  them,  are  apt  to  infect  other  persons.  Active  germs 
have  been  found  in  the  throats  of  recovered  diphtheria  patients 
three  months  after  the  disease  itself  apparently  disappeared, 
and  there  is  one  remarkable  case  on  record,  where  they  remained 
alive  for  twenty-two  months.  They  also  live  in  the  air,  in  water, 
and  elsewhere. 

In  consequence,  it  is  highly  important  that  children  who  are 
convalescent  be  kept  away  from  other  children.  They  should  be 
isolated  for  at  least  a  month,  and  it  is  unwise  to  send  them  to  school 
for  several  weeks  longer.  The  business  of  stamping  out  the  stray 
bacilli  which  may  happen  to  infect  the  sick-room  should  be  en- 
trusted to  some  one  who  knows  how  to  do  it.  The  common  device 
of  hanging  up  cloths  saturated  with  carbolic  acid  is  utterly  useless. 
In  many  cities  the  municipal  health  department  takes  charge  of 
all  disinfections. 

When  this  is  the  case,  it  is  very  unwise  for  mothers  to  offer 
opposition.  The  health  department  experts  know  what  they  are 
about,  and  their  work  may  very  easily  prevent  other  cases  in 
the  same  house  or  epidemics  in  the  neighborhood.  One  little  life 
saved  is  worth  all  the  bother  and  disorder  that  these  men,  with 
their  enmity  to  wall-papers,  cause  in  a  household. 

During  the  progress  of  a  case  of  diphtheria,  the  rooms  occupied 
by  the  patient— and  it  is  best  to  have  two  bedrooms,  that  there 
may  be  frequent  changes — should  be  isolated  absolutely  from  the 
rest  of  the  house,  and  it  is  advisable,  whenever  possible,  to  send 
all  the  other  children  of  the  house  away  and  withdraw  them  from 
school  until  all  possibility  that  they,  too,  are  infected  has  been 
eliminated. 

66 


It  is  best,  whenever  possible,  to  call  in  a  graduate  nurse,  but  too 
often  the  fear-stricken  mother  must  herself  assume  the  office  of 
bedside  attendant.  To  those  confronted  by  this  difficult  duty,  I 
would  suggest  the  importance  of  submitting  to  a  preventive  in- 
jection of  antitoxin.  Small  doses  for  this  purpose  are  especially 
prepared  by  the  various  manufacturers.  The  inoculation  causes 
little  discomfort  and  no  illness,  but  it  is  a  certain  preventive. 
Most  adults  are  immune  to  diphtheria,  but  the  importance  of  keep- 
ing the  nurse  in  good  health  throughout  the  period  of  nursing  is 
obvious,  and  so  it  is  well  to  take  no  chances. 

You  should  have  the  doctor  give  you  a  prescription  for  a  mouth 
gargle  and  use  it  every  hour.  In  addition  you  should  wash  your 
hands  at  frequent  intervals  with  antiseptic  soap.  All  spoons 
glasses  and  other  vessels  should  be  cleansed  with  a  three  per  cent, 
solution  of  carbolic  acid.  Toys,  cushions,  carpets,  pictures  and 
furniture — in  fact,  everything  movable — should  be  taken  from  the 
sick-room.  Its  furnishings  should  be  limited  entirely  to  the  bed, 
a  table  and  a  chair  for  the  nurse.  The  floor  and  walls  should  be 
sponged  once  a  day  with  a  one-tenth  of  one  per  cent,  solution  of 
bichloride  of  mercury.  The  bedclothes  and  garments  of  both 
patient  and  nurse  should  be  boiled,  and  all  sick-room  de"bris  should 
be  burned.  The  eyes,  nose  and  mouth  of  the  patient  should  be 
frequently  swabbed  with  moist  absorbent  cotton,  and  the  cotton 
should  then  be  burned. 

Not  a  solitary  person  besides  the  nurse  and  the  doctor  should 
be  permitted  to  enter  the  sick-room  under  any  circumstances. 
As  I  have  said,  most  adults  are  immune  to  diphtheria,  but  it  is 
perfectly  possible  for  them  to  carry  away  the  germs  and  infect 
children.  I  recently  encountered  in  my  own  practice  the  case  of 
a  drawing  teacher  who  infected  at  least  a  score  of  children  without 
being  ill  herself.  The  germs  of  the  disease  were  in  her  throat. 

The  nursing  of  a  case  of  diphtheria  requires  eternal  watchful- 
ness and  care.  Even  when  the  disease  is  making  favorable  pro- 
gress, there  is  danger  of  sudden  heart  failure  and  collapse,  and  the 
management  of  such  emergencies  is  beyond  the  skill  of  the  mother. 
If  your  little  patient  seems  to  be  fainting,  and  the  pulse  grows 
weak,  send  for  the  nearest  doctor  at  once.  In  any  case  the  con- 
valescent is  always  very  much  exhausted,  and  should  be  kept  in 
bed  a  good  while.  The  diet  should  be  rigidly  prescribed  by  the 
physician.  It  is  exceedingly  dangerous  to  add  a  coveted  dish  to 

67 


it — no  matter  how  harmless  that  dish  may  seem — without  his 
express  permission. 

Methods  of  preventing  diphtheria  will  present  themselves  to 
the  intelligent  mother.  The  notion  that  every  child  is  doomed  to 
suffer  from  the  disease  at  some  time  during  its  first  decade  (and 
to  suffer  attacks  of  a  long  string  of  other  infantile  epidemics,  like- 
wise) is  a  dangerous  and  stupid  error.  There  is  no  reason  whatever 
why  any  child  need  have  diphtheria,  scarlet  fever  or  measles,  just 
as  there  is  no  reason  why  it  need  have  smallpox,  lockjaw  or  hy- 
drophobia. All  of  these  infections  are  preventable. 

In  a  great  many  cases  kissing  spreads  diphtheria — particu- 
larly from  adults,  in  whose  mouths  the  germs  may  be  impotent, 
to  children.  Therefore,  the  custom  of  permitting  small  children 
to  be  fondled  and  kissed  by  every  sentimental  woman  relative  and 
visitor,  should  be  under  the  ban.  Again,  it  is  well  to  break  children 
of  the  habit  of  putting  things  into  their  mouths.  It  is  easy  to  do 
this,  and  the  precaution  may  save  lives.  Rubber  pacifiers,  the  toys 
used  to  divert  children  in  photograph  galleries,  and  other  things 
of  that  sort  frequently  swarm  with  the  bacilli. 

As  I  have  tried  to  show,  success  in  battling  with  diphtheria  de- 
pends almost  entirely  upon  promptness.  A  delay  in  sending  for 
the  doctor  is  often  fatal.  Whenever  a  child's  throat  is  sore,  and  a 
membrane  obstructs  the  air  passages,  it  is  safe  to  conclude  that 
there  is  some  diphtheretic  infection.  Even  a  mild  redness,  without 
membrane,  or  pain,  may  indicate  the  presence  of  the  disease.  Such 
a  mild  case  may  pursue  an  uneventful  and  unalarming  course — 
and  then  suddenly  ead  in  heart  failure.  It  is  best,  at  all  times, 
to  put  no  trust  in  home  remedies  for  the  treatment  of  sore  throats. 
Only  a  physician  is  capable  of  differentiating  between  diphtheria 
and  less  dangerous  infections. 

The  so-called  "pseudo-diphtheria"  of  the  old-school  family 
doctors  is  not  diphtheria  at  all,  but  a  milder  tonsil  infection  due  to 
the  presence  of  organisms  called  the  streptococcus  and  staphylo- 
coccus.  But  the  existence  of  such  an  infection  shows  that  the  little 
patient's  throat  membranes  afford  good  soil  for  germs,  and  so  it 
should  be  guarded  against  diphtheria  with  unusual  vigilance. 
Bad  teeth,  mouth  sores,  enlarged  tonsils,  catarrhal  inflammations 
and  other  abnormalities  in  the  respiratory  tract  also  predispose 
to  the  disease.  Susceptibility  is  increased,  again,  by  measles  and 
scarlet  fever.  In  the  majority  of  cases,  the  germs  first  find  a  lodg- 

68 


ment  in  the  tonsils.    Therefore,  it  is  a  wise  precaution  to  have 
enlarged  and  sensitive  tonsils  removed  in  early  infancy. 

When  a  child  has  been  exposed  to  infection,  and  the  fact  is  known, 
an  immunizing  injection  of  antitoxin  should  be  made  at  once. 
If  this  is  done  in  time,  the  disease  is  effectually  headed  off.  As 
I  have  said,  the  antitoxin  is  harmless,  and  cannot  possibly  injure 
a  healthy  child.  The  prejudice  against  it  (and  traces  of  this 
prejudice  are  to  be  encountered  among  ignorant,  old-fashioned 
doctors  as  well  as  among  silly  mothers)  is  doubtless  due  to  the  fact 
that  it  has  been  in  use  but  a  short  while.  Not  until  1894  was  its 
value  demonstrated,  and  only  since  1895  has  it  been  in  general 
use.  In  these  few  years,  I  should  say,  it  has  saved  the  lives  of  at 
least  three  hundred  thousand  children. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  XI 

What  is  the  one  thing  that  has  reduced  the  death-rate  from  diph- 
theria so  marvelously  in  the  last  ten  years? 

Diphtheria  antitoxin. 

How  soon  should  the  antitoxin  be  administered? 

As  soon  as  diphtheria  is  suspected  to  be  present. 

How  can  this  be  proved? 

A  "culture"  should  be  taken  of  the  patient's  throat. 

How  is  this  culture  taken  ? 

The  doctor  scrapes  the  patient's  throat  and  has  the  mucous 
examined  at  once  by  a  bacteriologist  to  see  if  the  diphtheria  germ 
is  present. 

How  can  a  mother  protect  the  family  from  taking  diphtheria  from 
the  patient  before  she  is  sure  it  is  diphtheria? 

She  should  call  a  doctor  for  tonsilitis  or  a  bad  sore  throat  and 
should  isolate  a  child  suffering  from  a  cold  or  sore  throat. 

How  can  she  prevent  the  disease  from  attacking  those  who  have  been 
exposed  to  itf 

She  should  at  once  notify  the  Board  of  Health.  Either  a 
Board  of  Health  doctor  or  her  private  physician  will  make  a  mild 
injection  of  antitoxin  for  each  person  exposed.  If  the  mother 
takes  care  of  the  child  she  should  have  such  an  injection  also, 
as  her  health  is  all-important  at  this  crisis. 

What  can  we  do  to  prevent  diphtheria? 

69 


Brush  the  teeth  thoroughly  after  each  meal;  use  a  mouth  wash; 
have  adenoid  growths  or  enlarged  tonsils  removed;  take  care  not 
to  infect  other  people  if  we  have  a  cold  or  sore  throat.    Take  care 
not  to  let  other  people  infect  us  if  they  have  a  cold  or  sore  throat. 
Never  kiss  one  another  on  the  mouth. 
How  can  we  prevent  diphtheria  epidemics  at  schoolf 
Diphtheria  germs  are  present  in  the  mouths  of  many  healthy 
persons.    These  persons  are  called  "germ  carriers."    A  "culture" 
should  be  taken  of  every  child's  throat  before  it  enters  school  in 
the  fall.     In  this  way  the  "germ  carriers"  can  be  weeded  out. 


70 


CHAPTER  XII.— IF  YOUR  BABY  HAD  SCARLET  FEVER 

OW  that  smallpox,  thanks  to  compulsory  vac- 
cination, has  become  a  rarity  in  civilized 
communities,  scarlet  fever  steps  forward  as 
the  worst  of  the  eruptive  diseases  of  childhood. 
It  is  a  malady  of  enormous  antiquity.  Thu- 
cydides,  writing  nearly  five  hundred  years 
before  the  beginning  of  our  era,  called  it  a 
heritage  from  the  remote  past.  It  has  scourged 
the  white  races  in  all  ages  and  all  countries,  and  the  physicians 
of  all  schools  have  leveled  their  heaviest  artillery  upon  it.  Yet  it 
remains  a  puzzle  unsolved  and  an  enemy  unconquered  even  to-day. 
We  are  in  doubt  as  to  its  cause,  and  there  is  as  yet  no  drug  or  anti- 
toxin that  will  cure  it. 

But  despite  all  this,  the  death-rate  from  scarlet  fever  is  steadily 
declining,  and  we  may  expect  it  to  decline  more  and  more  as  the 
years  go  by.  The  reason  for  this,  I  take  it,  lies  in  the  fact  that  the 
modern  doctor  is  a  great  deal  more  sparing  with  pills  and  powders 
than  his  predecessor,  and  a  great  deal  more  lavish  with  water, 
air  and  antiseptics.  In  the  old  days  it  was  customary  to  dose 
scarlet  fever  patients  with  all  sorts  of  violent  remedies,  in  staggering 
quantities,  and,  as  a  result,  many  of  them  died.  To-day  medi- 
cines are  but  minor  auxiliaries  in  the  sick-room,  and  both  doctor 
and  nurse  devote  their  main  energies  to  preventing  a  spread  of 
the  infection. 

Though  the  exact  cause  of  scarlet  fever  is  still  far  from  certain, 
there  is  no  doubt  whatever  that  it  will  be  determined  with  absolute 
accuracy  within  a  few  years.  A  large  number  of  competent  ob- 
servers, in  truth,  have  already  come  to  the  conclusion  that  the 
causative  agent  must  be  a  minute  parasite  closely  related  to  that 
which  produces  malaria.  The  organisms  of  diphtheria,  tuber- 
culosis and  most  other  common  maladies  belong  to  the  vegetable 
kingdom,  like  the  germs  of  the  yeast,  but  this  so-called  scarlet  fever 
organism  is  a  true  animal.  It  is  at  the  very  bottom  of  the  scale 

71 


of  brute  creation,  and  is  almost  as  far  below  the  caterpillar  as  the 
latter  is  below  the  highest  grade  of  man-like  ape. 

An  attack  of  scarlet  fever  may  begin  a  day  or  so  after  the  patient 
has  been  exposed  to  contagion,  and  then  again  there  may  be  an 
incubation  period  of  a  week  or  even  more.  Several  years  ago, 
in  the  course  of  my  practice,  I  one  day  visited  a  family  in  which 
there  were  four  bad  cases.  Next  day  I  left  the  city  and  remained 
away  for  a  full  week.  On  the  day  of  my  return  I  fell  ill  with  the 
disease,  and  a  very  severe  attack  was  immediately  in  progress.  In 
this  case  the  incubation  period  seems  to  have  been  no  less  than 
eight  days. 

Scarlet  fever  usually  begins  with  chills,  rising  fever,  headache, 
loss  of  appetite  and  pains  in  the  limbs,  and  sometimes,  particularly 
in  very  young  children,  with  convulsions.  A  sore  throat  and 
painful  tonsils  next  afflict  the  patient,  and  at  the  end  of  a  day  or 
so  the  characteristic  red  rash  appears.  This  commonly  begins 
around  ':he  neck  and  over  the  chest,  and  at  the  start  consists 
of  tiny  scarlet  blotches  the  size  of  pinheads.  The  blotches  soon 
run  together  and  the  whole  surface  of  the  body  becomes  a  brilliant 
red.  The  membranes  of  the  mouth  are  affected  in  much  the  same 
way,  and  the  tongue  becomes  swollen  and  takes  on  the  so-called 
"  raspberry ' '  appearance. 

Despite  the  almost  universal  notion,  there  is  no  crisis  in  scarlet 
fever.  A  crisis,  in  medicine,  means  a  sudden  change  in  or  termi- 
nation of  symptoms.  In  scarlet  fever  the  fever  does  not  cease 
suddenly,  but  slowly.  This  is  called  a  termination  by  lysis,  which 
is  the  very  reverse  of  crisis.  When  the  fever  goes  down — usually 
about  the  fifth  day — the  scarlet  rash  begins  to  disappear  and  the 
skin  of  the  patient  begins  to  peel  off.  Sometimes  it  comes  off  in 
large  patches,  and  the  skin  of  nearly  a  whole  hand  may  separate 
in  a  single  piece. 

When  this  peeling  has  fairly  begun,  the  malady  itself  may  be 
said  to  have  practically  run  its  course,  but  there  yet  remains 
a  grave  danger  from  serious  complications.  The  worst  of  these 
are  Bright 's  disease,  several  varieties  of  heart  disease  and  inflam- 
mation of  the  inner  ear.  Bright 's  disease,  as  every  one  knows, 
may  readily  lead  to  long  invalidism  and  death,  and  inflammation 
of  the  inner  ear  only  too  often  produces  meningitis,  abscesses  on 
the  brain,  or  permanent  deafness.  The  belief  that  scarlet  fever 
tends  to  leave  some  nasty  souvenir  of  its  visit  is  far  from  a  mere 

72 


superstition.  It  has  an  unpleasant  habit,  too,  of  paving  the  way 
for  other  acute  diseases,  such  as  pneumonia,  bronchitis  and  even 
diphtheria. 

All  this  makes  it  apparent  that  a  case  of  scarlet  fever  needs  very 
careful  nursing.  Whenever  it  is  possible  a  trained  nurse  should  be 
engaged,  and  in  any  event  the  doctor's  orders  should  be  obeyed 
with  scrupulous  exactness.  Nothing  could  be  more  foolish  than  the 
common  custom  of  seeking  advice  in  such  emergencies  from  grand- 
mothers, neighbors  who  have  " pulled  their  own  children  through" 
and  other  well-meaning,  but  blundering  "experts"  of  that  species. 
Good  nursing  means  not  only  intelligent  care  of  the  patient,  and 
a  capacity  for  quickly  and  accurately  recognizing  threatening 
complications,  but  also  intelligent  efforts  to  prevent  a  spread  of 
the  infection.  Scarlet  fever  is  one  of  the  most  contagious  of  known 
maladies,  and  in  achieving  an  effective  quarantine  of  his  patient 
the  cautious  physician  often  takes  measures  which,  to  the  layman, 
may  seem  almost  ridiculously  elaborate. 

When  one  of  your  children  develops  the  disease,  put  it  to  bed  in 
a  large  and  airy  room,  preferably  on  the  top  floor  of  the  house,  and 
prepare  another  room  nearby,  into  which  the  child  may  be  taken 
when  the  sick-room  proper  is  being  aired  and  cleaned.  Take  all 
unnecessary  furnishings  out  of  both  rooms.  Under  this  heading 
come  carpets,  rugs,  pictures,  draperies  and  ornaments.  In  the 
sick-room  a  bed  for  the  patient  and  a  chair  and  table  for  the  nurse 
are  about  all  that  may  be  called  needful.  A  plain  clothes-rack  will 
suffice  for  holding  the  necessary  changes  of  bed-clothes. 

If  it  is  at  all  possible,  send  the  other  children  of  the  household 
to  some  relative's  home  and  keep  them  away  from  school  for  a 
week.  If  they  are  apparently  well  at  the  end  of  that  time,  it  will 
be  safe  to  let  them  go  back  to  school.  If  sending  them  away  is 
out  of  the  question  and  they  must  remain  in  the  house,  keep  them 
away  from  all  other  children  until  the  patient  up-stairs  is  well. 
They  may  take  the  disease  at  any  time,  even  in  the  face  of  careful 
precautions,  and  you  certainly  would  be  greatly  grieved  to  see 
them  carry  it  to  their  fellow-pupils  and  playmates. 

If  you  are  able  to  engage  a  trained  nurse — or,  better  still,  two  of 
them — the  problem  of  nursing  is  much  simplified,  for  the  nurses 
will  carry  out  the  doctor's  orders  intelligently  and  faithfully,  and 
in  their  comings  and  goings  they  will  see  to  it  that  they  do  not  carry 
the  infection.  Your  own  visits  to  the  sick-room  should  be  as  far 

73 


apart  as  your  anxiety  will  permit  you  to  make  them,  you  should 
stay  but  a  short  while,  and  avoid  handling  the  patient.  Before 
you  enter  the  room  put  on  a  long  duster  or  rain  coat  that  com- 
pletely covers  your  ordinary  clothes.  Place  a  close-fitting  hood, 
such  as  housemaids  wear  when  dusting,  over  your  hair.  These 
garments  should  be  kept  at  the  sick-room  door.  When  you  leave, 
wash  your  hands  thoroughly,  putting  a  few  drops  of  carbolic  acid 
into  the  water.  After  that,  spend  half  an  hour  in  the  open  air 
and  sunlight. 

If  you  decide  to  nurse  your  child  yourself,  you  must  resign  your- 
self to  an  entire  separation  from  the  other  children  in  the  house  for 
a  period  of  at  least  six  weeks.  Your  bedroom  should  be  next 
to  or  very  near  that  of  the  patient,  of  course,  but  I  cannot  advise 
your  sleeping  in  the  sick-chamber  itself.  Besides  increasing  the 
chances  of  infection,  this  practice  results  in  unduly  vitiating  the  air 
of  the  room.  The  oxygen  that  you  consume  is  needed  by  the 
child,  for  in  a  sick-room  the  supply  of  oxygen  is  never  too  ample. 

With  proper  treatment,  the  patient  should  be  quiet  enough  to 
give  you  a  reasonable  amount  of  rest,  but  you  must  school  your- 
self to  awaken  easily  in  order  that  you  may  look  after  its  noc- 
turnal wants.  It  is  highly  important  that  you  go  out  every  day 
for  an  hour  or  so  for  fresh  air  and  exercise,  and  during  this  time 
some  one  else  must  be  on  guard.  This  assistant  nurse,  during  her 
stay  in  the  sick-room,  should  wear  the  long  coat  and  the  dust-cap 
I  have  already  described.  You,  yourself,  on  leaving  the  sick- 
room, should  make  a  complete  change  of  clothes,  and  wash  your 
face  and  hands  thoroughly.  The  clothes  you  wear  outside  should 
be  kept  in  an  ante-room. 

These  precautions  may  seem  unduly  elaborate,  but  in  view  of 
the  extraordinary  infectiousness  of  scarlet  fever,  they  are  not. 
In  my  own  practice  I  wear  a  skull-cap  and  long  rain  coat  whenever 
I  enter  the  room  of  a  patient  ill  with  the  disease.  In  addition, 
I  cover  my  mustache  and  beard  with  strips  of  sterile  cotton,  and 
see  to  the  surgical  cleanliness  of  my  hands — and  this  is  far  greater 
than  ordinary  soap-and-water  cleanliness — when  I  depart. 

In  the  sick-room,  for  general  antiseptic  purposes,  you  should 
keep  a  wooden  (not  a  metal)  bucket  filled  with  a  one-tenth  per 
cent,  solution  of  corrosive  sublimate.  The  drug  stores  sell  this 
powerful  germicide  in  convenient  tablet  form.  Use  one  tablet 
for  every  pint  of  water.  All  towels,  sheets  and  other  cloths  used 

74 


in  the  sick-room  should  be  soaked  in  this  solution  for  an  hour  be- 
fore they  are  placed  in  the  family  laundry  basket.  It  should  be 
used,  too,  instead  of  plain  water,  for  moistening  all  cloths  employed 
in  wiping  the  floor  and  furniture. 

You  know,  of  course,  that  corrosive  sublimate  is  a  most  violent 
poison,  but  this  fact  need  not  worry  you,  for  a  weak  solution,  such 
as  I  have  recommended,  can  do  little  damage.  After  it  wets  your 
hands,  wash  them  with  soap  and  water.  It  may  make  the  skin 
a  bit  dark  and  rough,  but  this  will  wear  off  very  quickly.  In  mop- 
ping the  floor,  see  that  the  cloth  is  moist,  and  not  soaking  wet. 
The  sick-room  must  never  be  dusty  (this  bans  all  sweeping),  but 
neither  should  it  be  steamy  and  damp. 

The  doctor  will  give  you  detailed  instructions  as  to  the  care  of 
the  patient.  The  little  sufferer  will  probably  be  greatly  annoyed 
by  the  discharges  from  its  nose,  throat  and  ears,  and  these  must 
constantly  be  looked  to.  Instead  of  a  handkerchief  or  napkin  for 
keeping  it  clean,  use  small  bits  of  the  absorbent  cotton  sold  by  every 
druggist.  This  cotton  is  cheap,  it  has  been  sterilized,  and  its 
application  is  not  irritating.  Every  piece  should  be  burned  im- 
mediately after  it  has  been  used. 

It  will  be  a  great  aid  to  the  doctor  if  you  can  give  him  an  accurate 
report  upon  the  varying  temperature  of  the  patient.  To  the  lay- 
man, taking  a  temperature  may  appear  difficult,  but  it  is  really 
a  very  simple  matter.  A  clinical  thermometer  costs  less  than  a 
dollar,  and  the  doctor  will  show  you  how  to  read  it.  If  the  patient 
is  afraid  to  hold  it  under  the  tongue,  place  it  in  the  rectum.  The 
normal  temperature  of  a  human  being  is  98.6  degrees  Fahrenheit. 
In  scarlet  fever  it  may  rise  to  103  or  even  105  degrees.  Whenever 
it  begins  to  grow  high,  the  doctor  should  be  informed  at  once. 

After  the  fever  goes  down  and  the  child's  skin  begins  to  shed, 
it  will  suffer  greatly  from  itching.  This  can  be  relieved  by  rubbing 
the  body  very  gently  with  carbolated  vaseline.  During  this  stage 
the  child  should  be  bathed  often  in  cold  lime-water  or  in  water 
which  contains  a  small  amount  of  ordinary  baking-soda.  Hot 
baths  are  to  be  avoided,  but  the  water  may  be  warmed  enough, 
as  the  phrase  goes,  "to  take  the  chill  off. "  Do  not  attempt  to  help 
nature  by  pulling  off  the  pieces  of  loose  skin.  They  will  drop  off 
themselves  just  as  soon  as  the  new  skin  beneath  them  is  hard 
enough  to  be  exposed. 

The  ancient  belief  that  a  sick-room  may  be  disinfected  by  hanging 

75 


up  cloths  saturated  with  weak  carbolic  acid  or  some  other  anti- 
septic is  without  a  basis  in  fact.  An  antiseptic,  to  kill  a  germ,must 
be  brought  into  actual  contact  with  it. 

That  is  why  all  towels  and  sheets  must  be  not  merely  dampened 
by,  but  actually  soaked  in,  the  corrosive  sublimate.  If  you  man- 
aged to  get  enough  carbolic  acid  into  the  air  to  kill  the  germs, 
you  would  kill  the  human  occupants,  too. 

Scarlet  fever  is  most  contagious  from  the  third  to  the  seventh 
day,  but  its  contagiousness  does  not  disappear  entirely  for  a  long 
while  after  that.  Until  the  shedding  of  the  skin  and  the  discharge 
from  the  ears  have  quite  ceased,  no  person  save  the  doctor  and  the 
nurses  should  be  permitted  to  approach  the  patient,  and  in  any  case 
the  period  of  quarantine  should  be  at  least  six  weeks. 

If  you  have  had  scarlet  fever  in  childhood  you  need  not  fear  for 
your  own  health,  but,  even  if  you  haven't,  your  chances  of  taking 
it  are  small.  It  is,  in  fact,  rare  among  adults,  but  all  the  same  it 
is  well  to  adopt  precautions. 

After  the  patient  has  recovered,  the  sick-room  should  be  thor- 
oughly cleansed;  and  this  means  cleansed  in  the  surgical,  and  not 
in  the  common,  sense.  In  large  cities  the  work  is  best  entrusted 
to  the  health  department.  When  such  experts  are  not  available, 
the  floor,  walls  and  ceilings  should  be  mopped  again  and  again 
with  the  corrosive  sublimate  solution,  and  the  windows  should 
be  thrown  wide  open.  It  is  always  best  to  have  the  wall-paper 
scraped  off. 

There  is  no  reason  to  fear  the  worst  when  the  doctor's  verdict 
is  scarlet  fever.  In  all  maladies,  you  should  remember  that  the 
death-rate  is  kept  up  by  the  enormous  number  of  deaths  among 
the  children  of  the  very  poor. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  XII 

What  is  the  one  thought  you  should  have  in  your  mind  where  there 
is  scarlet  fever? 

The  danger  of  one  case  of  scarlet  fever  in  a  town  to  the  rest  of 
the  community. 

Why? 

Because  scarlet  fever  is  one  of  the  most  contagious  of  diseases. 

Because  it  is  very  dangerous  and  leads  to  other  serious  diseases. 

76 


What  is  necessary  to  protect  a  community  against  scarlet  fever? 

That  every  case,  as  soon  as  it  is  discovered,  should  be  reported 
to  the  health  department. 

What  will  the  health  department  do? 

It  will  send  a  doctor  to  examine  the  child.  It  will  give  the 
mother  information  about  preventing  the  spread  of  the  disease  to 
the  other  children  in  her  family  or  in  the  town.  It  will  place  a 
sign  "scarlet  fever"  on  the  door  to  warn  people.  It  will  fumigate 
the  home. 

What  should  a  mother  do  if  the  health  department  does  not  take 
such  care  of  a  scarlet  fever  case? 

She  should  send  at  once  for  her  doctor  and  ask  him  how  to  care 
for  the  child  and  how  to  disinfect.  She  should  place  a  large  red 
letter  sign  SCARLET  FEVER  on  her  door  to  protect  her  neighbors. 
She  should  keep  all  the  persons  who  have  been  exposed  to  scarlet 
fever  away  from  other  persons,  and  the  children  away  from  school 
or  play  on  the  street  until  the  time  in  which  they  might  come  down 
with  the  disease  is  passed. 

What  are  the  precautions  to  be  taken  to  prevent  infection  from 
scarlet  fever? 

All  sheets,  nightgowns,  towels,  etc.,  used  by  the  patient  and  the 
nurse  should  be  soaked  twenty-four  hours  in  a  solution  of  carbolic 
acid  before  taken  from  the  sick-room,  then  thoroughly  boiled. 

Every  dish  used  in  the  sick-room  should  be  washed  in  carbolic 
acid  solution  before  taken  from  the  room. 

Every  book,  toy  or  article  that  cannot  be  boiled  should  be  burned. 
A  child  has  caught  scarlet  fever  from  a  book  that  had  been  in  the 
room  when  her  brother  had  scarlet  fever  two  years  before. 

No  letter  written  by  the  patient  should  be  permitted  to  leave  the 
room.  Allowing  an  infected  letter  to  go  through  the  mails,  carry- 
ing a  child  with  a  contagious  disease  through  the  street  car  or 
trains  is  a  crime  to  one's  fellowmen  that  should  be  punishable  by 
law.  If  it  is  necessary  to  take  a  child  in  a  hack  to  the  hospital  or 
home,  the  hack  should  be  fumigated  and  disinfected  before  being 
entered  by  another  person. 

How  long  is  there  danger  of  infection  from  a  scarlet  fever  case? 

Until  every  bit  of  the  old  skin — skin  that  peels  off— comes  off 
the  body  naturally. 

What  should  be  done  when  the  patient  recovers? 

It  should  be  bathed  and  its  hair  washed  in  disinfectant  before 

77 


leaving  the  room.  Place  a  clean  wrapper  at  the  door  and  have 
clean  clothes  for  it  in  another  room  where  it  may  get  dressed. 
Then  burn  a  formaldehyde  candle  in  the  room,  wash  the  floors  and 
the  woodwork  and  the  walls  with  a  solution  of  corrosive  sublimate. 
Then  the  wall  paper  should  be  torn  off  the  wall  and  the  room  should 
be  repapered. 

How  much  cheaper  is  this  than  another  case  of  scarlet  fever, 
perhaps  resulting  in  death. 


78 


CHAPTER  XIII.— WHOOPING  COUGH:    IT  KILLS 

MORE  CHILDREN  THAN  SCARLET  FEVER 

AND  DIPHTHERIA  TOGETHER 

HOOPING  cough  is  one  of  the  most  contagious 
of  all  maladies  of  childhood,  and,  in  very 
young  children,  one  of  the  most  dangerous. 
Personal  contact  is  not  necessary  in  order  to 
transfer  the  infection  from  one  child  to  an- 
other. Children  may  take  it  by  merely  enter- 
ing a  house  in  which  there  is  a  patient,  and 
*  some  observers  assert  that  it  may  even  be 
transmitted  from  child  to  child  on  the  street.  After  the  third 
year  it  is  not  often  fatal,  but  among  very  small  children  it 
plays  havoc.  During  the  whole  of  the  first  year  indeed,  it 
shows  a  death  rate  of  at  least  25  per  cent.  This  proves  how 
important  it  is  to  guard  babies  against  contagion.  The  notion 
that  whooping  cough  is  a  mild  disease,  which  every  child  would 
better  acquire  early,  for  its  subsequent  good,  is  a  costly  fallacy. 
We  are  yet  somewhat  in  the  dark  as  to  the  cause  of  whooping 
cough,  but  there  is  very  good  reason  to  hold  that  it  is  produced 
by  a  small  organism  allied  to  the  germs  of  the  other  infectious 
diseases.  This  organism,  it  is  possible,  enters  through  the  mouth 
or  nose  and  takes  up  its  home  in  the  larynx,  where  it  at  once  pro- 
ceeds to  irritate  and  destroy  the  mucous  membrane,  and  to  send 
forth  poisons  into  all  parts  of  the  body.  The  first  result  is  an 
accumulation  of  cellular  debris  and  mucous  in  the  larynx,  and  the 
second  is  a  serious  interference  with  the  normal  working  of 
the  bodily  machinery,  particularly  that  part  of  it  which  makes  up 
the  nervous  system. 

The  accumulation  in  the  larynx,  it  seems  likely,  is  the  direct 
cause  of  the  suffocating  cough,  though  certain  observers  believe 
that  the  principal  seat  of  trouble  is  elsewhere.  Whatever  the 
precise  mechanism,  it  is  plain  that  the  effort  in  the  cough  is  directed 
toward  ridding  the  larynx  of  its  obstruction,  and  that  the  ex- 

79 


pulsion  of  this  obstruction,  which  comes  up  in  the  form  of  a  sticky 
mass,  is  followed  by  a  cessation  of  the  paroxysm. 

Whooping  cough  starts  like  a  common  cold,  and  sometimes 
it  runs  so  mild  a  course  that  it  is  scarcely  recognizable.  But 
ordinarily,  its  peculiar  characteristics  begin  to  appear  after  a  few 
days.  One  of  these  is  the  tendency  of  the  cough  to  grow  worse 
at  night,  and  another  is  its  tendency  to  become  convulsive  and 
racking.  The  child  gasps  for  breath  after  each  attack  and 
seems  to  be  much  exhausted. 

In  a  week  or  ten  days  the  familiar  whoop  sets  all  doubts  at  rest. 
Anyone  who  has  ever  heard  this  whoop  will  never  forget  it.  It  is 
caused  by  the  labored  in-breathing  of  air  through  the  narrowed 
glottis,  and  well  exhibits  the  distress  of  the  patient.  The  cough 
itself  is  violent  in  the  extreme.  The  child,  as  if  suffocating,  grasps 
at  nearby  objects,  its  face  grows  red,  the  veins  of  its  neck  swell, 
the  tongue  protrudes  and  the  muscles  of  the  whole  upper  part  of 
the  body  are  strained.  After  each  effort  to  clear  the  air  passages 
there  comes  the  whoop.  Finally,  there  is  a  spasm  of  extra  violence, 
the  mass  of  mucous  is  expelled,  and  the  child  sinks  back  ex- 
hausted. 

It  is  common  for  vomiting  to  follow,  and  in  some  cases  this 
vomiting  is  so  severe  that  it  becomes  one  of  the  most  distressing 
symptoms.  At  times,  indeed,  the  patient  seems  unable  to  retain 
any  food  in  the  stomach.  In  such  cases,  of  course,  the  exhaustion 
becomes  progressively  more  severe,  and  the  physician  finds  the 
nutrition  of  the  patient  a  serious  problem. 

The  number  of  coughing  spells  in  the  twenty-four  hours  varies 
greatly,  and  is  modified  somewhat  by  the  care  exercised  in  nursing. 
A  sudden  draught  will  often  bring  on  a  severe  paroxysm,  as  will 
a  drink  of  cold  water.  Children  are  also  apt  to  start  coughing  on 
hearing  some  one  else  cough,  and  any  other  noise  or  shock  may 
have  the  same  effect.  The  paroxysms  are  always  more  frequent 
at  night,  and  between  the  severe  ones  there  may  be  a  large  num- 
ber of  lesser  ones. 

Very  little  can  be  done  to  shorten  or  mitigate  the  paroxysm, 
once  it  starts.  If  the  child  is  old  enough  to  stand  alone,  it  is  best, 
perhaps,  not  to  touch  it.  If  it  is  in  arms,  it  should  be  held  gently, 
but  firmly.  Inhalations  are  often  of  value,  but  they  can  be  used  to 
better  advantage  between  the  paroxysms  rather  than  during  their 
progress.  Often  the  mucous  coughed  up  is  bloody,  and  there  may 

80 


be  bleeding  from  the  nose  or  throat.  Unless  this  is  very  profuse 
it  need  cause  no  alarm. 

The  whooping  stage  continues  for  from  three  weeks  to  two  months, 
after  which  the  cough  grows  milder,  the  vomiting  ceases  and  the 
child  begins  to  regain  strength.  Even  when  there  are  no  complica- 
tions, whooping  cough  is  a  very  exhausting  malady,  and  so  it  is 
necessary  to  observe  the  child  closely  during  convalesence.  It 
should  get  plenty  of  fresh  air,  but  it  must  be  guarded  against  cold, 
for  an  ordinary  cold,  at  this  stage,  may  quickly  lead  to  pneumonia. 
A  visit  to  the  seashore,  if  it  does  not  involve  a  long  journey,  and 
the  weather  is  fine,  is  an  excellent  means  of  hastening  convalesence. 

In  the  absence  of  a  definite  cure  for  the  disease,  the  treatment 
of  whooping  cough  is  a  battle  with  symptoms  and  complications, 
and  these  are  so  numerous  and  so  various  in  their  manifestations 
that  it  is  impossible  to  give  general  advice.  A  severe  case  taxes 
the  ingenuity  and  experience  of  a  specialist,  and  so  it  is  apparent 
that  the  home  treatment,  so  often  depended  upon,  is  highly  danger- 
ous. As  soon  as  your  child  develops  a  bad  cough,  send  for  a  phy- 
sician; and  do  not  grow  impatient  if  he  fails  to  make  an  immediate 
diagnosis  and  give  the  patient  instant  relief.  As  I  have  said,  it  is 
often  difficult  to  detect  whooping  cough  during  the  first  week.  It 
is  possible,  indeed,  for  a  child  to  have  the  disease  and  yet  never 
whoop,  and  it  is  possible,  again,  for  a  child  to  whoop,  and  yet  not 
have  whooping  cough.  A  child  who  has  once  had  the  malady  is 
very  apt  to  whoop  for  years  afterward,  whenever  it  takes  cold. 

Cleanliness  and  fresh  air  are  just  as  important  in  the  treatment 
of  whooping  cough  as  they  are  in  measles  or  pneumonia.  Let 
the  room  in  which  the  patient  is  confined  be  cheerful  and  sunny, 
and  whenever  possible  give  it  two  rooms,  so  that  one  may  be  cleaned 
and  disinfected  while  the  other  is  in  use.  If  the  weather  is  fine 
and  it  is  strong  enough,  it  should  be  taken  out  for  an  airing  every 
day.  But  if  the  air  is  damp,  or  there  is  a  wind,  it  would  best  be 
kept  indoors. 

The  complication  most  to  be  feared,  during  the  winter  months, 
is  pneumonia.  During  the  summer,  particularly  if  the  patient  is 
very  young,  there  is  almost  equal  danger  from  diarrhea.  In  order 
to  ward  off  the  latter  it  is  necessary  to  exercise  great  care  in  the 
diet.  The  patient's  meals  should  have  diluted  milk  and  egg-albumen 
for  their  mainstays,  and  there  should  be  no  feeding  of  raw  fruits 
or  red  meats,  save  with  the  consent  of  the  physician.  Among 

81 


infants  convulsions  are  not  infrequent,  and  often  they  cause  death. 
Despite  the  appalling  fight  for  breath  during  the  paroxysms  of 
coughing,  it  is  seldom  that  a  patient  dies  by  actual  suffocation. 

Whooping  cough  is  such  a  contagious  malady,  and  runs  such  a 
long  course  that  it  is  never  safe  to  keep  other  children  under  the 
same  roof  with  a  patient.  As  soon  as  the  disease  is  detected,  let 
the  other  children  be  sent  away  at  once  to  some  house  in  which 
they  will  be  the  only  youngsters,  and  keep  them  away  from  school 
for  sixteen  days.  If,  at  the  end  of  that  time,  they  appear  to  be  in 
good  health,  they  may  be  sent  back  to  school. 

All  of  these  precautions  are  necessary  because  there  is  good 
reason  to  believe  that  whooping  cough  is  contagious,  not  only  during 
the  whooping  stage,  but  also  in  the  very  earliest  stage.  Thus  a 
child  who  seems  at  the  moment  to  have  nothing  worse  than  a 
mild  cold  may  yet  spread  whooping  cough  from  end  to  end  of  a 
large  school.  Where  a  hundred  children  are  exposed  to  the  in- 
fection, it  is  not  uncommon  for  90  to  develop  the  disease.  It  is, 
indeed,  one  of  the  most  virulent  of  childhood's  plagues,  and  as  I 
have  shown,  one  of  the  most  dangerous.  In  the  United  States 
to-day,  it  kills  more  children  each  year  than  scarlet  fever. 

The  room  in  which  a  patient  sleeps  should  be  disinfected  every 
ten  days.  In  order  that  this  may  be  done,  of  course,  the  patient 
must  be  moved  to  another  room.  As  soon  as  aH  is  in  readiness 
swab  the  furniture  with  a  weak  solution  of  bichloride  of  mercury 
or  carbolic  acid.  Then  close  the  room  tightly  and  burn  a  for- 
maldehyde candle.  After  an  hour  or  so,  throw  open  the  windows, 
and  let  the  fumes  of  the  formaldehyde  escape.  If  this  is  done  early 
in  the  morning,  it  is  usually  possible  for  a  child  to  sleep  in  the  room 
that  night. 

The  virtue  of  this  disinfection  lies  in  the  fact  that  a  child  recover- 
ing from  whooping  cough  sometimes  seems  to  become  reinfected, 
probably  from  the  bed-clothes  or  other  furnishings.  In  other 
words,  the  patient  apparently  acquires  the  disease  all  over  again, 
when  on  the  road  to  recovery.  Disinfection  minimizes  this  danger, 
and  in  addition  it  disposes  of  all  the  stray  germs  that  may  have 
wandered  in  and  so  reduces  the  danger  of  pneumonia  and  other  com- 
plications. 

It  is  not  wise  to  let  the  patient  come  into  contact  with  other 
children  until  at  least  a  month  after  the  whooping  has  ceased. 
Even  then,  it  is  best  that  it  sleep  alone  for  another  month.  Before 

82 


the  rooms  in  which  it  has  been  housed  while  ill  are  used  by  other 
children  they  must  be  disinfected  in  a  thorough  manner.  This 
may  be  done  with  the  antiseptic  solutions  and  the  formaldehyde, 
using  both  more  freely  than  in  the  periodic  disinfections,  but  it  is 
advisable,  whenever  possible,  to  have  the  work  done  by  experts. 
In  all  large  cities  the  health  department  will  send  men  to  do  it, 
sometimes  for  a  small  fee  and  sometimes  without  charge. 

There  are  dozens  of  patented  remedies  for  whooping  cough  and 
all  of  them  now  bear  the  misleading  notice  "Guaranteed  under  the 
Pure  Food  and  Drug  Act."  The  layman  fancies  that  this  notice 
signifies,  in  some  mysterious  manner,  that  the  national  government 
endorses  the  extravagant  claims  of  the  makers.  As  a  matter  of 
fact,  it  does  nothing  of  the  sort.  All  it  proves  is  that  the  nostrum 
contains  no  more  of  certain  specified  poisons  than  is  indicated  on 
the  label.  Innumerable  drugs  which,  under  the  law,  need  not  be 
specified  on  the  label,  are  extremely  dangerous. 

It  may  be  stated  with  all  due  fairness  to  the  patent  medicine 
men,  that  not  one  of  their  cough  syrups  and  elixirs  is  of  value  in 
whooping  cough.  True  enough,  some  of  them  may  contain  drugs 
which,  in  the  hands  of  a  competent  physician,  may  be  of  appreciable 
service,  but  all  of  these  do  far  more  harm  than  good  if  the  dosage 
is  not  adapted  to  the  peculiar  needs  of  the  individual  patient,  and 
all  of  them  are  very  apt  to  upset  the  stomach.  Vomiting  and 
diarrhea  are  common  enough  in  whooping  cough  as  it  is.  Drugs 
in  the  stomach  are  always  foes  of  an  uneventful  recovery,  and  the 
physician,  when  he  gives  them  at  all,  does  so  with  great  care  and 
great  reluctance. 

The  common  home  remedies  are  even  worse  than  the  drug- 
store messes.  Those  ghastly  infusions  of  camomile  and  other 
herbs,  so  often  prescribed  by  wise  old  grandmothers  to  provoke 
perspiration,  and  so  "sweat  out  the  fever,"  are  the  advance  agents 
of  pneumonia.  So  are  all  the  ancient  plasters  and  poultices  of 
the  family  medicine  chest.  Let  them  be  anathema! 

I  sometimes  think,  indeed,  that  the  degree  of  civilization  of  a 
community  may  be  judged  by  the  contents  of  its  average  family 
medicine  chest.  In  the  old  days  this  chest  bulged  with  herbs, 
barks,  roots,  soothing  syrups,  headache  powders,  lint,  salves  and 
ointments.  Paregoric  was  in  the  place  of  honor,  and  behind  it 
stood  carboys  of  arnica  and  sweet  spirits  of  nitre. 

In  the  future,  I  fancy,  the  medicine  chest  will  be  smaller  and 

83 


less  horrifying.  It  will  contain  a  box  of  aseptic  cotton,  a  bottle 
of  carbolic  vaseline,  a  bottle  of  castor  oil,  a  hot  water  bag  and  very 
little  else. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  XIII 

Why  should  whooping  cough  be  especially  avoided? 

Because  the  mortality  is  very  high,  especially  among  very  young 
children.  Babies  who  have  whooping  cough  are  more  likely  to 
develop  pneumonia  in  the  winter  time  and  diarrhea  in  the  summer 
time.  Tuberculosis  often  results  from  the  physical  debility  caused 
by  whooping  cough. 

Should  a  child  with  whooping  cough  be  isolated? 

Yes.  Whooping  cough  is  so  exceedingly  contagious  that  it  is 
not  safe  to  have  other  children  in  the  same  house  with  a  whooping 
cough  patient. 

Should  a  child  with  whooping  cough  be  allowed  to  go  to  school? 

No.  One  case  of  whooping  cough  can  infect  a  school  from  end 
to  end.  Though  children  with  whooping  cough  are  able  to  run 
about,  they  should  be  kept  away  from  all  other  children. 

What  is  the  best  way  to  get  rid  of  whooping  cough? 

The  room  in  which  the  child  sleeps  should  be  disinfected  every 
ten  days.  Whooping  cough  is  so  exceedingly  infectious  that  the 
child  can  reinfect  itself,  thus  prolonging  the  disease.  Sheets, 
bedding  and  clothes  should  be  soaked  in  carbolic  acid  solution; 
woodwork  and  floors  and  walls  should  be  washed  down  with  this 
solution,  and  a  formaldehyde  candle  burned  every  ten  days. 

Is  it  necessary  to  have  a  doctor  for  whooping  cough? 

By  all  means.  It  is  not  safe  to  use  any  home  remedies  or  patent 
medicines.  Let  the  doctor  watch  the  little  patient  very  closely. 
A  child  with  whooping  cough  should  be  warmly  clothed,  but  should 
have  plenty  of  fresh  air. 


84 


CHAPTER  XIV.— IF  YOUR  BABY  HAD  PNEUMONIA 

HE  sinister  distinction  of  holding  first  place 
upon  the  American  table  of  mortality  belongs 
to  pneumonia,  a  disease  of  the  lungs.  It 
causes  more  than  one-tenth  of  all  the  deaths 
that  occur  in  the  United  States  each  year. 
It  slays  the  babe  of  a  few  months  and  the 
grandfather  of  fourscore  years.  It  lays  low 
the  rich  and  the  poor,  the  sturdy  and  the  weak, 
the  overfed  and  the  starving.  And  it  is  one  of  the  few  diseases 
that  the  modern  physician  can  do  little  to  combat.  When  the 
patient  gets  well,  it  is  nearly  always  nature  that  works  the  cure 
— nature  and,  be  it  added,  good  nursing. 

In  view  of  this  fact  it  is  plain  that  every  American  mother  should 
endeavor  to  learn  something  about  the  malady,  for  it  is  upon  her, 
when  the  patient  is  a  child,  that  the  burden  of  nursing  commonly 
falls. 

Reduced  to  its  elementals,  pneumonia  is  nothing  more  than  a 
clogging  up  of  the  lungs,  due  to  the  presence  and  activity  of  count- 
less hordes  of  some  breed  or  other  of  virulent  germ. 

As  every  one  knows,  oxygen  enters  the  body  through  the  nostrils 
and  the  windpipe,  as  a  result  of  the  act  of  breathing.  At  its  lower 
end  the  windpipe  divides  into  two  branches — the  bronchial  tubes 
— one  of  which  makes  off  to  the  right  and  the  other  to  the  left. 
At  the  end  of  each  bronchial  tube  there  is  a  further  division,  and 
at  the  end  of  each  division  another  one,  and  so  on.  The  incoming 
oxygen,  proceeding  down  these  constantly  dividing  passages, 
comes  at  last  to  the  ultimate  lung-cells. 

Now,  when  virulent  germs  invade  the  lungs,  the  blood  and  tissues 
make  an  effort  to  paralyze  and  kill  them,  and  the  result  of  the 
battle  is  a  mass  of  debris — dead  germs,  broken-off  lung  cells,  mucous, 
dead  blood-cells  and  other  things.  This  debris  fills  many  of  the 
lung-cells  and  puts  thousands  of  them  out  of  commission.  In 
consequence  the  blood  gets  less  oxygen  than  it  should  get,  and  the 

85 


heart  tries  to  make  up  for  the  deficiency  by  pumping  blood  into  the 
remaining  clear  cells  a  good  deal  faster  than  usual,  and  by  making 
the  lungs  breathe  faster.  This  plan  works  very  well  for  a  while, 
and  if  the  blood  makes  good  progress  in  killing  the  invading  germs 
and  the  debris  is  quickly  absorbed  or  coughed  up,  the  difficulty 
will  be  tided  over  and  the  lungs  will  soon  be  working  normally 
again.  But  sometimes  so  many  cells  are  clogged  up  that  the  blood 
can  not  get  enough  oxygen,  no  matter  how  hard  the  heart  works, 
and  then  there  is  great  danger  of  collapse  and  death.  Again,  the 
germs  may  send  out  poisons  which  paralyze  the  heart,  and  then 
there  is  great  danger,  too.  All  this  proves,  you  will  observe,  that 
pneumonia,  though  a  lung  disease,  makes  its  final  onslaught  upon 
the  heart. 

The  foremost  pathologists  in  the  world  have  been  trying  for  many 
years  to  discover  some  specific  for  pneumonia,  but  so  far  their 
efforts  have  been  in  vain.  That  is  to  say,  there  is  nothing  under 
the  sun  that  will  directly  kill  the  germs  or  directly  aid  the  blood 
in  its  war  upon  them.  It  is  possible,  of  course,  to  assist  nature  by 
combating  the  fever  which  appears  with  the  disease.  What  the 
patient  most  needs  is  a  clean  bed  and  plenty  of  air.  Given  these 
things  and  a  good  constitution,  the  blood  will  fight  the  germs, 
rout  them,  kill  them  and  get  rid  of  them.  The  chances  are  always 
in  favor  of  recovery. 

An  attack  of  pneumonia  begins  in  a  manner  which  suggests  a 
very  bad  cold.  The  patient  has  a  chill  and  a  fever  and  suffers 
from  pains  in  the  side.  A  cough  soon  appears  and  the  breath 
becomes  short  and  quick.  The  valiant  battle  of  the  overworked 
heart  is  indicated  by  a  quick  pulse  and  flushed  cheeks.  Soon  there 
are  signs  of  great  exhaustion,  with  headache,  sleeplessness  and 
(sometimes)  delirium. 

During  all  of  this  period  the  blood  is  waging  a  tremendous  war 
upon  the  invading  germs.  If  it  is  destined  to  lose,  the  exhaustion 
will  grow  more  and  more  marked  and  the  patient  will  die.  But 
if  it  is  destined  to  win  there  will  come  a  time — it  will  be  between 
the  fifth  and  the  tenth  day — when  the  patient  will  suddenly  seem 
brighter.  The  temperature  will  fall,  the  breathing  will  be  more 
regular,  and  the  violent  jumping  of  the  pulse  will  cease.  When 
this  happens  it  is  a  sign  that  the  battle  is  won. 

But  though  the  germs  have  been  conquered,  it  is  just  at  this 
stage  that  careful  nursing  is  most  needed.  The  lungs  are  full  of 

86 


purulent  wreckage,  and  the  business  of  getting  rid  of  this  is  difficult. 
The  attack  itself  has  greatly  exhausted  the  patient,  and  his  strength 
is  next  to  nothing.  Good  nursing  must  recruit  it  for  him — nursing 
which  takes  the  form  of  plenty  of  fresh  air  and  a  supply  of  easily 
assimilated  food. 

The  fact  that  pneumonia  might  be  called  simply  a  shutting-off 
of  oxygen  shows  how  important  it  is  to  give  the  patient  plenty  of 
air.  In  several  large  New  York  hospitals,  indeed,  sufferers  from  the 
disease  are  carried  to  the  roof,  and  kept  there  day  and  night. 
When  your  child  grows  ill,  move  it  to  the  largest  and  sunniest  room 
in  the  house,  and  open  the  windows.  If  it  is  too  cold  for  that, 
have  another  room  near  by,  into  which  the  patient  may  be  moved 
at  least  three  times  a  day,  to  permit  a  thorough  ventilation  of  the 
sick-room.  All  unnecessary  furniture  and  all  pictures,  hangings 
and  other  impedimenta  should  be  taken  out  of  both  rooms. 

It  is  dangerous  to  permit  pneumonia  patients  to  remain  too  long 
in  one  position.  They  should  be  moved  about  often,  and  should 
be  frequently  propped  up  with  pillows.  The  notion  that  the  child 
must  be  buried  in  blankets  to  protect  it  from  "catching  cold"  is 
little  more  than  a  mere  superstition.  The  child  already  has  the 
worst  of  all  conceivable  colds,  and  what  it  needs,  beyond  every- 
thing else,  is  air  and  freedom  of  movement. 

When  the  little  patient's  temperature  ranges  alarmingly  high, 
some  means  should  be  employed  to  bring  this  temperature  down, 
but  this  means  should  never  take  the  form  of  drugs.  The  use  of 
such  things  as  phenacetine,  antipyrin,  acetanilid  and  their  combina- 
tions is  exceedingly  hazardous,  on  account  of  their  interference  with 
the  proper  working  of  the  heart.  Quinine  is  almost  as  bad.  The 
best  thing  to  do  is  to  sponge  the  baby  with  alcohol  or  cold  water. 
Next  after  that  comes  the  use  of  ice-bags  and  compresses. 

During  the  bath  it  is  a  good  plan  to  rub  the  child's  skin  all  over — 
of  course,  very  gently.  This  has  a  good  effect  upon  the  circulation, 
and  tends  to  prevent  delirium  and  restlessness.  In  addition,  there 
is  probably  some  more  subtle  psychic  effect.  Every  one  knows 
how  pleasant  it  is  to  be  gently  massaged — how  it  drives  away  pain, 
calms  the  nerves  and  produces  a  feeling  of  healthfulness  and  well- 
being.  Sleep  and  comparative  comfort  usually  follow  the  bath 
and  rubbing  down.  Upon  the  reappearance  of  any  nervous 
symptoms,  repeat  the  bath. 

As  I  have  said,  it  is  impossible  to  aid  the  body  directly  in  its 

87 


struggle  with  the  pneumonia  organisms,  but  there  are  countless 
ways  of  giving  it  indirect  assistance.  When  a  cough  is  severe,  for 
example,  a  good  effect  is  often  produced  by  the  inhalation  of  the 
vapors  of  creosote,  carbolic  acid  or  menthol.  Again,  alcohol 
and  other  stimulants  are  often  capable  of  lending  the  heart  a  hand 
at  a  critical  moment.  But  it  is  not  well  for  the  mother  to  employ 
such  things  on  her  own  responsibility.  Have  the  doctor  give  you 
full  instructions,  and  then  carry  them  out  faithfully. 

There  are  so  many  varieties  of  pneumonia  that  it  would  be  im- 
possible to  specify  all  of  them.  What  is  known  as  broncho-pneu- 
monia is  the  most  common  form  among  small  children.  Six  times 
out  of  ten  it  appears  as  a  sequel  to  whooping  cough  or  some  other 
infantile  ailment,  and  is  then  usually  traceable  to  faulty  nursing. 
It  represents,  indeed,  nothing  more  than  a  transfer  of  the  germ 
of  some  disease  to  the  lungs. 

True  lobar  pneumonia  usually  comes  on  suddenly,  like  a  bolt 
from  the  blue,  and  not  as  a  sequel  of  some  other  malady.  It  is 
most  common  between. the  ages  of  three  and  eight  and  usually 
attacks  children  who  have  seemed  to  be  perfectly  healthy.  It 
always  follows  the  course  I  have  described,  whereas  bronchial 
pneumonia  may  drag  on  for  weeks,  and  in  some  cases  may  become 
genuinely  chronic.  The  immediate  death-rate  in  lobar  pneumonia 
is  higher  than  in  the  bronchial  variety,  but,  in  the  long  run,  it  is 
less  to  be  dreaded,  for  it  is  seldom  marked  by  relapses,  and  re- 
covery, when  it  occurs,  is  always  complete. 

After  a  child  has  had  pneumonia,  no  matter  what  form  of  the 
malady,  and  convalescence  has  begun,  it  is  best  to  take  it  to  the 
country.  The  disease  leaves  the  body  enormously  thirsty  for 
fresh  air;  and  fresh  air,  in  a  large  city,  is  almost  a  curiosity.  Be- 
sides that,  a  change  of  scene  is  always  of  great  benefit  during  re- 
covery. Unluckily,  pneumonia  confers  no  durable  immunity. 
As  a  matter  of  fact,  the  recovered  patient  is  more  liable  to  the 
disease  than  it  was  before  the  attack.  In  addition,  its  weakened 
lungs  afford  unusually  good  soil  for  the  germs  of  other  maladies, 
too,  and  one  of  these  is  tuberculosis.  Fresh  air  is  the  only  thing 
that  can  reduce  this  liability. 

At  times,  pneumonia  sweeps  through  an  entire  household,  and 
in  all  cases  it  is  well  to  isolate  the  patient,  particularly  when  there 
are  other  children  in  the  house.  Your  own  child  may  be  protected 
against  pneumonia  by  very  simple  precautions.  See  that  it  gets 

88 


wholesome,  easily  digested  food  and  that  it  has  plenty  of  air,  day 
and  night.  Too  much  coddling  is  the  principal  cause  of  childish 
ailments. 

You  may  think  that  fresh  air  causes  colds,  but  as  a  matter  of 
fact  the  very  reverse  is  true.  The  child  that  is  always  taking  cold 
is  the  child  who  has  been  coddled  and  whose  mode  of  life  ill  adapts 
it  to  meeting  the  vicissitudes  of  existence  here  on  earth.  It  is 
part  of  life  for  all  of  us,  now  and  then,  to  stand  in  drafts  and  to 
get  our  feet  wet.  No  matter  how  much  we  try  to  avoid  it,  we  must 
do  so  at  frequent  intervals.  Therefore,  the  thing  to  do  with  a 
child  is,  not  to  make  a  vain  attempt  to  protect  it  against  acci- 
dental and  inevitable  exposure,  but  so  to  rear  it  that  it  will  be 
able  to  face  such  exposure  without  damage.  A  cold  is  always 
a  sign  of  a  low  power  of  resistance.  The  entirely  healthy  human 
being  never  takes  cold. 

Therefore,  when  your  baby  begins  to  cough  and  snuffle,  send 
for  your  doctor  and  have  him  examine  it.  The  very  fact  that  it 
is  coughing  is  proof  that  it  needs  attention.  The  doctor's  visit, 
if  it  is  made  in  time,  may  head  off  an  attack  of  pneumonia.  Most 
mothers  regard  a  cold  as  a  trivial  and  harmless  thing,  but,  as  I 
have  shown,  it  is  not.  The  difference  between  a  cold  and  pneu- 
monia is  one  of  degree  only,  and  not  one  of  kind.  Both  are  definite 
infections,  and  both  prove,  with  equal  force,  that  the  little  pa- 
tient is  not  as  well  fitted  as  he  should  be  to  survive  in  the  struggle 
for  existence. 

In  conclusion,  let  me  warn  all  mothers  who  read  this  chapter  to 
remember  that  there  is  no  reason  for  flying  into  a  panic  when  the 
doctor's  verdict  is  "  pneumonia. "  Given  good  and  faithful  nursing 
and  obedience  to  the  doctor's  orders,  there  is  no  reason  why  your 
child  should  not  get  well.  In  all  cases,  no  matter  how  serious,  the 
chances  are  in  favor  of  recovery. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  XIV 

What  is  the  one  preventive  as  well  as  cure  for  pneumonia? 
Fresh  air. 

How  will  fresh  air  cure  pneumonia? 

Pneumonia  is  a  disease  that  shuts  off  oxygen  from  the  lungs. 
Therefore  the  patient  needs  to  get  as  much  fresh  air  as  possible. 

89 


• 


Its  bed  should  be  put  on  the  piazza  or  roof  or  under  a  large 
window. 

How  will  fresh  air  prevent  pneumonia? 

It  builds  up  the  body,  makes  a  child  hardy,  and  its  blood  able 
to  resist  cold  and  pneumonia  germs.  Keep  the  children  out  of 
doors  all  day.  Let  them  sleep  in  the  open  air  at  night  and  do  not 
worry  about  pneumonia. 

Why  should  a  cold  be  treated  as  if  it  were  the  most  serious  of  diseases? 

Because  it  is  a  sign  that  the  child  is  run  down;  that  its  body  is 
in  a  condition  to  be  attacked  by  other  germs.  Because  a  cold 
neglected  may  lead  to  pneumonia  or  even  tuberculosis.  Because 
a  cold  is  often  a  symptom  of  a  contagious  disease.  If  the  child  is 
not  isolated,  the  family  or  school  may  be  exposed  to  contagion. 

Why  should  a  child  with  a  cold  have  a  thorough  physical  examina- 
tion by  a  doctor  ? 

Not  only  that  he  may  prevent  the  cold  from  developing  into 
something  more  serious,  but  because  it  is  a  sign  that  the  child  needs 
a  change  of  air,  of  food  or  habits.  It  is  often  a  sign  that  the  child 
has  adenoids,  and  adenoids  may  open  the  way  for  pneumonia  or 
tuberculosis. 

Why  should  a  pneumonia  patient  have  the  constant  care  of  a  physi- 
cian and  a  graduate  nurse? 

Because  the  death  rate  from  pneumonia  is  very  great  and  is 
constantly  increasing ;  because  the  disease  is  so  severe  and  short. 
Three,  two  or  even  one  day  may  decide  whether  an  attack  of 
pneumonia  means  life  or  death. 

What  care  should  a  convalescent  have? 

He  should  have  his  lungs  thoroughly  examined,  have  a  "  culture" 
taken  to  be  sure  he  has  not  tuberculosis.  He  should  take  pains 
to  avoid  fatigue,  over-heated  rooms;  should  make  a  point  of  eating 
plenty  of  nourishing  food,  and  of  keeping  out  in  the  fresh  air. 


90 


CHAPTER  XV.— NEED  EVERY  CHILD  HAVE  MEASLES? 

EXT  to  the  common  cold,  measles  is  probably 
the  most  wide-spread  of  all  infectious  diseases, 
at  least  in  civilized  countries.  Almost  every- 
one gets  over  it,  many  do  not.  This  has 
led  to  the  popular  idea  that  measles  is  some- 
thing to  be  regarded  lightly,  and  that  it  is 
best,  all  things  considered,  for  a  child  to  take 
it  and  have  it  over.  Nothing  could  be  further 
In  itself,  perhaps  measles  is  seldom  a  direct 
cause  of  death,  but  too  often  it  leaves  the  body  in  a  very 
debilitated  state,  and  other,  and  worse,  maladies  come  in  its  train. 
Thus,  like  influenza,  it  is  chiefly  to  be  feared,  not  on  its  own 
account,  but  on  account  of  the  things  that  follow  it. 

No  one  has  yet  succeeded  in  tracking  down,  with  certainty,  the 
germ  that  causes  measles.  We  know  that  the  cause  is  a  germ,  be- 
cause its  effects  and  mode  of  multiplication  are  exactly  those  of  other 
germs,  but  beside  the  fact  that  it  is  an  animal  parasite  we  know 
very  little  else  about  it.  Until  we  learn  more,  it  will  be  impossible 
to  make  a  direct  war  upon  it.  Even  now,  of  course,  we  can  take 
measures  to  prevent  its  spread  from  one  person  to  another,  and 
after  it  has  begun  its  work  we  can  deal  with  symptoms  and  com- 
plications it  produces,  but  we  know  of  no  way  to  kill  it,  once  it 
has  invaded  the  body,  and  we  know  of  no  way  to  limit  or  modify 
its  activity  there. 

Fortunately  for  us,  nature  knows  more  than  we  do.  As  soon 
as  the  measles  germ  enters  the  body,  nature  begins  to  battle  with  it, 
and  in  the  vast  majority  of  cases  she  succeeds  in  stamping  it  out. 
This  battle  is  begun  automatically,  and — unless  death  intervenes — 
it  always  proceed  s  in  a  more  or  less  regular  manner.  In  consequence 
we  say  that  measles  is  a  self-limiting  disease,  which  means  that  it 
runs  a  clearly-marked  course,  beginning  with  the  first  appearance 
of  the  germs  in  the  body  and  ending  with  their  complete  destruction 
and  expulsion. 

91 


The  more  obvious  signs  of  measles — the  fever,  the  lassitude, 
the  sore  eyes,  running  nose,  and  sore  throat,  and  beyond  all,  the 
red  rash — are  familiar  to  every  one.  There  are,  in  addition, 
several  signs  which  give  earlier  warning,  but  which  are  seldom 
perceptible,  save  to  the  physician.  One  of  them  is  Koplik's  sign,  so 
called  after  the  New  York  pathologist  who  first  noticed  it.  It  con- 
sists in  the  appearance  of  small  blue-white  specks  on  the  mucous 
membrane  lining  the  inside  of  the  cheeks.  These  specks  usually 
appear  two  or  three  days  before  the  rash  and  so  they  give  the  physi- 
cian a  chance  to  be  forewarned  and  forearmed.  They  explain  why  it 
is  that  when  a  child  complains  of  feeling  ill  and  shows  a  rising 
fever,  the  doctor  usually  makes  a  thorough  examination  of  its 
mouth. 

After  a  child  has  been  exposed  to  measles,  it  takes  from  eleven 
to  fourteen  days  for  the  disease  to  develop.  The  first  symptom 
is  a  general  feeling  of  illness  and  uneasiness,  with  the  signs,  perhaps, 
of  a  bad  cold  in  the  head.  Then  the  eyes  begin  to  water,  the  tem- 
perature rises,  the  throat  becomes  sore,  there  is  a  cough,  and  on 
the  third  or  fourth  day  the  characteristic  eruption  appears.  As  a 
rule,  it  is  first  seen  along  the  edge  of  the  hair — on  the  forehead  or 
neck,  or  behind  the  ears.  It  is  made  up  of  small,  dark-red  spots, 
often  some  distance  apart  and  flat  with  the  skin.  These  spots 
soon  begin  to  swell  and  multiply,  and  in  a  short  while  the  whole 
face  is  covered  with  them  and  they  begin  to  appear  on  the  neck 
and  chest,  and  so  on  down  to  the  feet.  By  the  time  they  reach  the 
feet,  they  are  commonly  beginning  to  dry  up  upon  the  face.  Usual- 
ly they  are  in  groups,  with  areas  of  clear  skin  between,  but  some- 
times they  cover  the  face  so  thickly  that  scarcely  a  speck  of  clear 
skin  is  to  be  seen.  At  such  times,  the  whole  face  is  swelled  and 
the  eyes  are  almost  closed. 

There  are  three  or  four  days  of  this,  and  then  the  little  pustules 
begin  to  grow  pale  and  dry.  This  is  the  period  of  desquamation, 
or  shedding.  The  dead  skin  breaks  off  into  small  scales,  much 
resembling  bran,  and  the  new  skin  begins  to  appear  underneath. 
In  scarlet  fever  the  skin  comes  off  in  large  patches,  but  in  measles 
the  scales  are  small.  Often,  indeed,  they  are  so  small  that  they 
are  scarcely  noticed. 

This  shedding  continues,  as  a  rule,  from  five  to  ten  days,  though 
occasionally  it  may  be  prolonged  to  two  weeks.  It  is  accompanied 
by  annoying  itching,  and  there  is  commonly  some  cough  too,  and 

92 


a  lingering  weakness  in  the  eyes,  but  otherwise  the  patient  begins 
to  feel  perfectly  well  again.  The  appetite  returns,  the  fever  has 
abated,  and,  if  all  has  gone  well,  there  is  nothing  amiss  in  throat 
or  lungs. 

Sometimes  the  rash  in  measles  is  so  severe  that  the  small  blood 
vessels  in  the  skin  are  broken  down,  and  the  blood  in  them  comes 
out.  The  blood  collects  under  the  surface  of  the  skin  in  small 
dark  patches,  much  as  in  a  bruise  or  black  eye.  This  condition 
was  described  by  the  older  doctors  as  "black  measles,"  and  it  was 
believed  that  death  almost  invariably  followed.  But,  as  a  matter 
of  fact,  the  appearance  of  these  dark  spots  need  not  cause  a  panic. 
As  a  rule,  true  enough,  they  indicate  a  case  worse  than  the  average, 
but  they  have  been  noted,  also,  in  comparatively  mild  cases,  and 
in  themselves  they  do  no  harm.  It  often  happens  that  a  few 
such  haemorrhagic  eruptions  appear  in  the  course  of  an  ordinary 
case. 

As  I  have  said,  nothing  can  be  done  to  cure  measles,  as  we  can 
cure  malaria,  diphtheria  or  a  broken  arm.  The  disease  must  run 
its  course,  and  we  can  never  even  tell  how  long  that  course  is  going 
to  be,  save  very  roughly.  But  it  is  perfectly  possible  to  guard 
the  little  patient  against  the  disastrous  complications  which  lurk 
along  the  trail  of  the  measles  germ,  and  it  is  possible,  too,  to  re- 
lieve much  of  the  patient's  suffering.  In  accomplishing  this, 
the  nurse  plays  a  part  more  important  perhaps  than  that  of  the 
doctor. 

As  soon  as  a  child  grows  ill  and  feverish,  and  begins  to  complain 
of  discomfort  in  the  eyes  and  nasal  passages,  it  should  be  put  to 
bed  in  a  well- ventilated,  darkened  room,  and  the  physician  should 
be  summoned.  So  many  infantile  maladies  begin  in  the  same 
way  that  it  is  often  impossible,  at  this  stage,  to  say  whether  the 
little  patient  is  developing  measles,  scarlet  fever,  influenza,  or 
merely  a  cold,  but  it  is  always  best,  whenever  it  shows  a  fever, 
however  slight,  to  put  it  to  bed.  In  a  day  or  two,  more  certain 
diagnosis  will  follow  the  first  doubt. 

Let  me  say  here  with  all  possible  emphasis,  that  putting  a  child 
to  bed  does  not  mean  burying  it  beneath  a  matterhorn  of  woolen 
blankets.  There  is  a  popular  notion,  that,  in  all  maladies  accom- 
panied by  fever,  a  vigorous  and  constant  perspiration  is  beneficial 
and  necessary,  but  this  is  scarcely  true.  Sweating  will  not  modify 
the  course  of  meaeles,  and  neither  will  bad  air,  except  in  an  un- 

93 


favorable  way.  See  that  the  patient  is  well  protected  from  all 
draughts,  but  let  the  blankets  be  light  enough  for  comfort,  and 
make  sure  that  there  is  constant  ingress  of  fresh  air  into  the  room. 

As  a  help  toward  that  sweating  which  woolen  blankets,  how- 
ever thick,  only  partly  achieve,  it  is  customary,  among  amateur 
nurses,  to  employ  vast  doses  of  various  hot  teas.  All  such  dis- 
gusting messes  should  be  thrown  to  the  dogs.  Camomile,  sassafras 
or  what-not — they  do  a  lot  of  harm  and  no  good  at  all.  It  is 
difficult  to  make  the  average  grandmother  believe  that  camomile 
is  a  fraud,  and  so,  when  she  recommends  it  and  you  refuse  to 
administer  it,  she  will  go  away  offended,  but  it  is  far  better  to 
offend  her  than  to  injure  your  child.  All  the  little  patient  needs, 
in  the  way  of  drink,  is  plenty  of  cooled  water — not  ice  water, 
but  water  of  the  ordinary  hydrant  temperature.  Do  not  keep 
a  pitcher  full  in  the  sick-room,  but  draw  a  fresh  glass  of  a  pure  or 
boiled  water  that  has  been  cooled  whenever  it  is  wanted.  Day 
or  night,  never  deny  the  child  a  drink. 

Regarding  the  food  to  be  given  to  the  patient,  it  is  best  to  consult 
the  attending  physician  in  the  particular  instance.  In  an  ordinary 
case  of  measles,  the  child  will  be  satisfied  with  milk,  soft-boiled 
eggs  and  meat  broths  during  its  few  days  of  severe  illness,  and 
may  approach  its  usual  diet  soon  thereafter,  but  in  case  there  are 
complications,  particularly  in  the  digestive  tract,  great  care  in 
feeding  must  be  exercised.  Have  the  doctor  draw  up  a  bill  of 
fare  and  fix  the  meal  times,  and  then  stick  to  the  schedule  religious- 
ly. A  feverish  child  requires  very  little  food  and  it  is  best  never 
to  try  to  force  it  to  eat. 

The  patient's  eyes  will  probably  be  inflamed  and  painful.  Keep 
them  clean  by  swabbing  them  every  few  hours  with  a  little  mop 
of  sterilized  cotton  that  has  been  dipped  into  a  solution  of  boracic 
acid.  The  cotton  comes  in  boxes  to  be  had  for  ten  cents  or  a 
quarter  at  any  drug  store.  Never  use  ordinary  raw  cotton,  for  no 
matter  how  clean  it  may  seem,  it  is  always  full  of  irritating  particles 
and  the  germs  of  various  diseases.  The  boracic  acid  is  a  near 
relative  to  borax  and  may  be  had  at  the  drug-store.  Put  a  table- 
spoonful  into  a  tumbler  of  water  and  use  the  clear  solution. 

If  there  is  so  much  discharge  from  the  eyes  that  the  lids  stick 
together,  dip  a  piece  of  the  sterilized  cotton  into  vaseline  and  gently 
smear  the  edges  of  the  lids.  Sometimes  the  eyes^are  so  painful 
and  so  much  inflamed  that  it  is  necessary  to  apply  ice-packs  to 

94 


them.  When  this  is  necessary,  the  doctor  will  show  you  how  to 
do  it. 

There  is  a  great  deal  of  itching  in  measles,  particularly  after 
the  dead  skin  begins  to  shed.  To  relieve  it,  apply  a  thin  film  of 
vaseline — either  the  plain  or  the  carbolated.  Besides  reducing  the 
itching,  this  will  loosen  the  scales  and  so  help  the  process  of  des- 
quamation.  But  never  rub  the  skin!  The  friction  of  the  wash- 
rag  or  cotton  and  the  clothing  is  all  that  nature  needs. 

During  the  few  days  of  fever,  of  course,  the  child  need  be  bathed 
only  at  the  doctor's  orders.  As  soon  as  the  shedding  begins  it 
should  have  a  daily  warm  bath.  This  should  be  given  with  the 
room  warm  and  all  the  windows  closed,  and  it  should  not  be  pro- 
longed. Use  a  very  soft  wash-cloth  or  absorbent  cotton  and  little, 
if  any,  soap ;  and  after  drying,  anoint  all  those  parts  of  the  body 
upon  which  the  rash  has  appeared  with  vaseline.  The  physician 
may  prescribe  some  other  ointment,  but  if  he  does  not  it  is  best  to 
use  only  vaseline.  The  common  drug-store  salves  and  ointments 
may  do  a  great  deal  of  harm. 

The  child's  cough,  headache,  sore  throat  and  other  discomforts 
must  be  combatted,  not  by  the  nurse,  but  by  the  physician.  Aside 
from  its  simple  food  and  its  plentiful  supply  of  cooled  water,  it 
should  take  nothing  into  its  stomach  that  has  not  been  prescribed 
by  its  medical  attendant.  There  are  dozens  of  grandmothers' 
elixirs  for  the  various  symptoms  of  measles,  and  all  of  them  are 
abominations.  From  boneset  tea  to  sweet  spirits  of  nitre  they 
are  dangerous  frauds,  one  and  all. 

Measles  is  an  exceedingly  contagious  disease,  but  its  virulence, 
unlike  that  of  scarlet  fever,  does  not  last  very  long.  As  soon 
as  a  case  appears  in  a  household,  all  of  the  other  children  should 
be  kept  from  school,  but  it  is  unnecessary  to  send  them  out  of  the 
house.  The  room  in  which  the  patient  is  being  nursed  should  be 
isolated  from  the  rest  of  the  house,  with  as  rigid  a  quarantine 
as  if  the  contagion  was  always  fatal.  If  the  mother  is  the  nurse, 
she  should  keep  away  from  the  other  children  until  at  least  two 
weeks  after  the  patient  has  recovered.  It  is  possible  for  a  child  to 
take  measles  by  merely  passing  the  open  door  of  a  room  in  which 
a  patient  is  confined. 

If,  as  often  happens,  there  are  two  patients  at  the  same  time, 
it  is  best,  whenever  possible,  to  put  them  into  separate  rooms. 
This  is  because  the  more  dangerous  maladies  which  sometimes 

95 


follow  or  complicate  measles,  such  as  pneumonia,  are  apt  to  be 
communicated  from  one  patient  to  another.  Herein,  no  doubt, 
we  find  an  explanation  of  the  fact  that  epidemics  of  measles  are 
always  more  severe  in  boarding-schools  and  orphan-asylums  than 
among  children  at  home.  One  patient,  developing  pneumonia 
or  diphtheria,  communicates  it  to  many  others. 

Inasmuch  as  measles  is  already  contagious  before  its  outward 
signs  appear — that  is,  during  the  period  of  incubation,  or  breeding — 
it  is  exceedingly  difficult  to  protect  a  child  against  it,  particularly 
if  the  child  goes  to  school  or  to  Sunday  School,  or  otherwise  as- 
sociates with  its  fellows.  But  in  the  case  of  weakly  children,  it 
is  well  to  make  extraordinary  efforts  to  secure  this  protection, 
for  measles,  in  such  children,  very  frequently  leads  to  pneumonia, 
chronic  bronchitis,  and  even  tuberculosis.  If,  after  an  attack,  the 
patient  continues  to  cough  and  to  remain  weak,  it  should  be  sent 
into  the  country;  preferably,  to  the  mountains.  The  seeds 
of  life-long  illness  and  early  death  are  sowed  by  apparently  mild 
attacks  of  measles. 

A  week  after  the  last  signs  of  shedding  have  disappeared  it  is 
safe  to  permit  the  patient  to  mingle  again  with  other  children. 
But  before  the  room  in  which  it  has  been  confined  is  used  as  a 
sleeping  apartment,  it  should  be  thoroughly  disinfected.  The 
measles  germs  do  not  cling  to  life  very  vigorously,  and  outside  of 
the  human  body  they  soon  die,  but  it  is  well  to  take  no  chances. 


QUESTIONS  FOR  THE  MOTHER  ABOUT  CHAPTER  XV 

Why  should  every  precaution  be  taken  to  protect  a  child  from  measlesf 

Because  though  it  is  not  often  fatal,  it  weakens  the  child  so  that 
it  readily  takes  other  diseases. 

What  are  the  first  signs  of  measles? 

A  cold,  fever,  sore  throat  and  weariness ;  later  a  red  rash  and 
blue-white  spots  inside  the  cheeks. 

Why  should  a  child  with  measles  be  quarantined? 

Because  measles  is  contagious  and  it  is  not  fair  to  other  children 
to  give  them  a  disease  that  may  lower  their  vitality  and  pave  the 
way  for  other  diseases. 

How  long  should  a  child  that  has  been  exposed  to  measles  be  kept 
away  from  other  children? 

96 


It  takes  from  eleven  to  fourteen  days  for  the  disease  to  develop. 

What  precautions  should  be  taken  to  prevent  the  spread  of  measles? 

Measles  should  be  reported  to  the  Board  of  Health;  a  sign 
MEASLES  should  be  put  on  the  door.  No  one  but  the  nurse 
should  be  allowed  to  go  into  the  child's  room  or  to  pass  the  door 
when  it  is  open.  The  room  should  be  thoroughly  fumigated  before 
it  is  used  again. 

What  are  the  special  precautions  to  prevent  bad  after-effects  from 
measles? 

The  room  should  be  kept  dark,  and  the  child  should  not  be  al- 
lowed to  read,  write  or  sew  or  to  use  its  eyes  at  any  close-range 
work.  Great  care  should  be  taken  that  the  child  does  not  catch 
cold.  This  does  not  mean  that  all  the  windows  should  be  kept 
closed.  Fresh  air  in  a  sick-room  is  the  best  preventive  of  colds. 
The  lungs  and  throat  of  a  child  should  be  thoroughly  examined 
after  measles,  and  it  should  have  rest,  nourishing  food  and  out- 
door life  until  its  health  is  thoroughly  restored. 


97 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 
BERKELEY 

Return  to  desk  from  which  borrowed. 
This  book  is  DUE  on  the  last  date  stamped  below. 

XT-I-fTT'  I 


FEB    21959 
rEB    2 1959 


LD  21-100»»-7,'52(A2528sl6)476 


